General Information and Health Forms

Please click on the link and print the forms, fill out at your convenience and bring to your first appointment. You may also fill out the forms in the office. If you are unable to print the forms, call us for help at 505-897-6560

General Information Form pdf

Treatment Consent Forms / HIPAA

The Consent Forms include 4 Forms.

• The First form is called a " Hippa Form" , which explains how our clinic secures the privacy of your medical information.
• The Second Form is a "Moxa Consent " form, which allows our doctor to use the application of Moxibustion. Moxa is an herb that is burned for the application of heat to an area of the body. For example, it is often used to treat chronic low back pain along with acupuncture. It is very effective when used in the appropriate circumstances.
• The Third Form is the "Arbitration Agreement" , an agreement to use arbitration instead of a medical lawsuit. Our insurance requires this form.
• The Forth Form is the "Acupuncture Informed Consent" , this is your consent to be treated with Acupuncture, Chinese Herbs and Oriental Medicine in general.