Acupuncture Therapy
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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 in advance, please arrive 20 minutes before your scheduled appointment time to fill them out in the office.

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

​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
Acupuncture Therapy 
​704-651-9585
4919 Unionville-Indian Trail Rd. W, #202 
    Indian Trail, NC 28079​
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  • Home
  • Services
  • Office Visit & Rates
  • FAQ
  • Meet Tamara
  • Testimonials
  • Blog
  • Contact