WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Pure Acupuncture & Natural Medicine offers our patient form(s) online so they can be completed it 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 Patient Forms - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding acupuncture can we help you with? Let us know!

 Click Here for Our New Patient Forms.

 Click Here for Our New Patient Welcome Letter

 Click Here for Our General Consent Form.

 Click Here for Our Metabolic Assessment Form.

 Click Here for Our Medical Release Authorization Form.


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form


Weight Loss Questionnaire

Download & Print Form

Download the Free AdobeReader®