NEW PATIENT FORMS

For ALL appointments EXCEPT microneedling/nanoneedling, please use the three forms under the "healthcare" section. For microneedling/nanoneedling appointments, please use the two forms under the "microneedling/nanoneedling" section.

 

Please print, carefully read, fully complete, and sign the following documents before coming to your first scheduled appointment. There will be a 15-30 minute consultation before your treatment begins using these forms. Any questions regarding the procedure or forms can be discussed during the consultation.

You may attach a copy of your medical records and/or medication list
to the Health History form rather than complete those sections if it is easier for you.

HEALTHCARE

ACUPUNCTURE & CUPPING

 

Please note that if your paperwork has not been completed or you forget to bring it
to your scheduled appointment; you may be asked to reschedule and you will not be treated. 

You will also be charged a $30, non-refundable fee. 

MICRONEEDLING & NANONEEDLING

 

Please note that if your paperwork has not been completed or you forget to bring it
to your scheduled appointment; you may be asked to reschedule and you will not be treated. 

You will also be charged a $30, non-refundable fee.