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Barefoot Doctor Community Acupuncture Clinic » Forms

Forms

June 13th, 2008 by admin

Prior to your first appointment you are able to download and print the forms that we require at your initial visit.  This can save you time in the office, however, if you do not have access to a printer you may arrive a few minutes early for your appointment to fill them out.

  • Welcome to Community Acupuncture- This form gives you a detailed explanation about what you can expect from treatment at the Barefoot Doctor Community Acupuncture Clinic. It also describes your responsibility as a patient and the process of acupuncture.  (Does not need to be printed)
  • Payment Schedule - Sliding Scale - This form gives a detailed explanation of the Clinic’s sliding scale. Based on your income, you can figure out what your treatment fee will be.  (Does not need to be printed)
  • Health History Form- The Health History Form will ask you to provide the acupuncturist with detailed information about your health and the reasons for your visit.  Please print and fill out for first visit.
  • Informed Consent- Please print and sign this form upon first visit
  • Cancellation Policy - The Cancellation Policy form explains procedures for missed appointments and payment.  Please print and sign this form upon first visit.