The following forms are formatted for Microsoft Word. 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

Consent Form
for both Acupuncture and Oriental Wellness Therapy
(please read and sign before first office call)
 

Oriental Wellness Therapy Intake
monthly questionnaire for Oriental Wellness treatments
(not necessary for Acupuncture visits)
 

If you have any difficulty downloading or printing these documents, we'd be happy so send copies via mail.

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

Rob Singer L.Ac, MTCM
(541) 434-0474
Rob@Eternal-Circle.net

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