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Online Forms

Pure Acupuncture & Natural Medicine offers patient form(s) online so you can complete them in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patients Acupuncture Forms

Acupuncture New Patient Form
Office Policy and Doctor Lien
Patient HIPAA Questionnaire
Notice of Privacy Practices
General Consent & Records Release Form

Facial Acupuncture - MeiZen Forms

MeiZen Welcome Letter
MeiZen Facial Acupuncture Consent to Treat Form
MeiZen Photographic Consent Form

Nutritional and Herbal Forms

Symptom Survey Form
Consent for Intramuscular Vitamin + Trigger Point Injection
Weight Loss Questionnaire

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Two Locations to Serve You!

Office Hours

Lake Mary Location


10:00 am-1:00 pm

3:00 pm-6:00 pm


3:00 pm-7:00 pm


10:00 am-1:00 pm

3:00 pm-6:00 pm




10:00 am-1:00 pm

3:00 pm-7:00 pm


By Appointment



  • "Dr Scott is by far one of the most passionate and excellent Acupuncturists I have ever known. She gets great results, is technically superior and an excellent diagnostician. If you haven't tried acupuncture, Dr Sheila Scott is a great place to start."
    Neal W.