New Patient Forms

New Client Forms

For your convenience we have made some of our new patient forms available online. Please download the forms below, print them out, complete the forms, and bring them to your first appointment.

If you are unable to complete these forms ahead of your first appointment, please plan to arrive 20 minutes early.

The Informed Consent Form obtains your permission to be treated as a patient and advises you of possible side effects from various treatments that are available in this clinic.

DOWNLOAD CONSENT FORM

The Notice of Privacy Form explains the process of accessing and releasing your private health information.
DOWNLAD NOTICE OF PRIVACY FORM

The Health History Form gives a detailed picture of your health throughout your life. The Symptoms Checklist will help me understand your condition and create your treatment plan.
DOWNLOAD HEALTH HISORY FORM

Proudly serving the greater Charlotte metropolitan area, including Matthews, Indian Trail, Mint Hill, and Monroe.
We offer acupuncture, electro-acupuncture, cupping, herbal and nutritional supplementation, and other techniques of Chinese Medicine to address physical and emotional harmony, pain, headaches, anxiety, infertility, allergies, insomnia, digestive issues, facial cosmetic needs, addictions, and many other health concerns. Acupuncture benefits are numerous!