| Form Title |
Description |
| Protecting Your Information |
This notice describes our office’s policy for how medical information about you may be used and disclosed, how you can get access to this information, and how your privacy is being protected. |
| Patient Privacy Disclosure |
Describes how your private health information is protected by federal and state law. |
| Policy Acknowledgement |
Acknowledgement of having read and understood the following forms:
"Our Practice Protects Your Health Information and Privacy" (Protecting Your Information) and "Patient Privacy Disclosure" |
| Consent & Financial Policy |
An informed consent and financial policy for all acupuncture treatments. |
| Health Questionnaire |
A detailed questionnaire providing the practice with up to date information about the clients health. |
| Health Insurance Verification |
Used to verify a patient's health insurance information. |
| Pain Diagram |
A diagram that allows patients to indicate the location and types of pain they experience. |
| Auto Accident Information |
A detailed questionnaire to be filled out by patients who are seeking treatment due to an auto accident. |
| Medical Records Release |
Authorization to release personal medical records to an individual or medical entity. |
| Arbitration Agreement |
Arbitration agreement pertaining to disputes of medical malpractice. |
| What Is Vitamin B6 |
What is vitamin B6? Why should I get a vitamin B6 injection? |
| Vitamin B12 Deficiencies |
What are the benefits of vitamin B12? How do you become vitamin B12 deficient? |
