Acupuncture and Chinese Herbal Medicine Forms
New patient forms
Instructions for completing forms
Prior to arriving for your first appointment, complete the new patient forms and bring them with you. Do not print on both sides of the paper. You may be asked to complete additional forms when you arrive.
If you prefer, the clinic can provide forms for you. Arrive 20 minutes before your appointment time to complete the forms. If you are unsure of how to answer, check with the front desk staff.
To print forms:
- You may have to save the PDF to your computer first, open the PDf and then print
- DO NOT print on both sides of the paper
New patient form:
Auto or work-related injury forms
If you have an auto or work-related injury, report it to your insurance company or employer prior to contacting the clinic.
For questions, contact:
Bloomington Natural Care Center
952-886-7588, option 1