Acupuncture and Chinese Herbal Medicine Forms

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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 early to your appointment 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 forms:

For questions, contact:

University Health Services - De Rusha Clinic

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