Forms

Prior to your first appointment you will need to download and print each of the following forms. Please read and fill out each form carefully.

• 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.
•  Health History Form- The Health History Form will ask you to provide the acupuncturist with detailed information about your health and the health of your family.
• 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.
• Financial Policy - The Financial Policy form explains procedures for missed appointments and payment.
• Informed Consent- Please read and sign this form upon first visit