You can use this page to download forms that are commonly used. You can download the necessary forms, print them out and fill them in the comfort of your home. Bring these to the clinic when you arrive. This will speed up the time you spend before beginning your treatment.

 

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Personal  consent form for acupuncture treatment   Download Button
Authorization for release of Health Information pursuant to HIPAA               Download Button
Patient Personal Information Form       sds
Patient  Medical History Form    Download Button
   

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Advance Beneficiary Notice                                                                       Download Button
Personal  Consent Form for Acupuncture Treatment                                            Download Button
Patient Personal Information Form      Download Button
Patient  Medical History Form  Download Button
        

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Authorization for release of Health Information pursuant to HIPAA  Download Button
NY DMV Application for motor vehicle No-Fault Benefits  Download Button
NY DMV Verification of treatment be physician/provider of Health Service  Download Button
Patient Personal Information Form  Download Button
Patient  Medical History Form  Download Button
   

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Personal  consent form for acupuncture treatment                                   Download Button
Authorization for release of Health Information pursuant to HIPAA  Download Button
Patient Personal Information Form     Download Button
Patient  Medical History Form  Download Button
   
Worker's Compensation Law Sec.32 Form A-9      Download Button
WCL Sec.110-a Authorization to disclose Workers' Compensation Records  Download Button