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Rob Singer L.Ac
Whitsitt Goodson
L.Ac
Peter Chabarek L.Ac
Acupuncturists


541-521-6285

Acu4You@Gmail.com
2833 Willamette St.Suite E
Eugene, OR

Office Hours
10:00am-6:30pm
T  10:00am-6:30pm
W  9:00am-7:30pm
TH 10:00am-6:30pm
F 10:00am-6:00pm
Sat 9:00am-1:00pm

FORMS

The following forms are formatted for Adobe Reader (PDF). Simply download the file and print them out. Please fill out the forms to the best of your ability and bring them with you to your first visit.
 

Health History Questionnaire
for first office call Acupuncture visits
(even Stop Smoking Special)


For Women

For Men
If quitting smoking please read -

STOP SMOKING

*try printing double-sided to save paper!

If you have any difficulty downloading or printing these documents, we'd be happy so send copies via mail. Of course, you can always fill them out at the office. Just plan on arriving 20 minutes before your first visit.

Also, feel free to contact us with any questions about filling out the forms.

Rob Singer L.Ac
ACUPUNCTURE for the PEOPLE
(541) 521-6285
Acu4You@Gmail.com

Welcome • Health Conditions • Chinese Medicine • What to expect • Sliding Scale
Appointments • Policies • About Us • Testimonials • Forms • Map • Links