New Acupuncture Client Intake

Estimated time to complete : 1-3 minutes

Congratulations in taking steps towards a healthier existence, and towards getting the support you need. Moving towards improvement begins with us getting to know your needs and your wants. The better we understand you, the better we can help you.

***Please note that you should come to your first visit with your current insurance benefit information checked and confirmed as you may have a deductible to meet before mental health counseling is covered by your plan.


Thanks for selecting me as your Acupuncturist. I hope you have enjoyed reading my background and getting a feel for who I am and my focus. I look forward to meeting with you, learning more about your path, and working towards your goals.

In order to set you up with your first appointment, I need to gather some information. Please take a few moments to fill in your details below and then click the continue button.

Note: The nature of email communication means confidentiality can not be guaranteed.


You MUST click the continue button below to proceed.