AG Acupuncture

Patient Forms

Please download, print, and complete the forms below before your first appointment.

New Patient Intake

Complete health history and reason for visit.

↓ Download

Notice of Privacy Policies

How your personal health information is used and protected.

↓ Download

Office Policies

Practice guidelines, cancellation policy, and appointment expectations.

↓ Download

Arbitration Agreement

Agreement for resolution of any disputes.

↓ Download

The above documents are available for download in PDF format. Adobe Reader (version 8 or higher) is required to open PDF files and can be downloaded from Adobe.com.

Call, Text, or Email to Book914.572.5057 · [email protected]