Health Forms

The following forms are in PDF format. Please print the relevant forms, fill them out and bring them to your first appointment.

• Welcome letter and consent form


• Patient information (long form)


• Patient information (short form)


• Insurance information & checklist


• HIPAA Notice of Privacy Practices


• Acknowledgement of Receipt of Privacy Practices Policy


• Arbitration Agreement

Helpful Links

Here are some links you may find useful:

• Acupuncture.com – Home of Traditional Chinese Medicine


• NCCAOM – The National Certification Commission for Acupuncture and Oriental Medicine


• Eastern School of Acupuncture and Traditional Medicine


• New Jersey Division of Consumer Affairs – Acupuncture Examining Board


• dōTerra

Recipes

The following recipes are in PDF format.

• Detox Bath


• Liver/Gall Bladder Cleanse


• Kiiko Matsumoto's Psoriasis Treatment