Forms

If you're coming in for the first time, please print the following forms and have them filled out before your appointment. Your practitioner will go through all of them with you as well, so don't worry if you don't understand something or have any questions. 

 

If you don't have access to a printer, please read through the forms to have an idea of what's on them and then arrive 20 minutes earlier than your scheduled appointment time to fill them out. 

Download
Beachside Community Acupuncture New Patient Paperwork
Acupuncture Intake (pages 1-4): You'll share your contact information, medical history, and current health conditions.
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Evaluation by Physician and Cancellation Policy (page 5): Licensed Acupuncturists are not considered primary care practitioners in the state of Texas, which means that someone else - such as a physician or chiropractor - must also have seen you and know about your condition. On the top half of this page you'll verify that you have been evaluated by someone else or are coming in to relieve chronic pain, to quit smoking or another addiction, or to lose weight, all of which are exempt from this rule. On the second half of the page you will agree to our cancellation policy, in which we require 24 hours' notice of a cancelled appointment.
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Consent and HIPAA (page 6): You'll give your consent to receive treatment and acknowledge that you've read our privacy practices, which you can find below but do not need to print.
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Beachside New Patient Forms.pdf
Adobe Acrobat Document 443.6 KB
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Privacy Practices (Do Not Need to Print)
Please read through these practices before signing the HIPAA Acknowledgement. You may print these for your records if you choose, but it's not necessary to bring them with you to the clinic.
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Privacy Practices.pdf
Adobe Acrobat Document 128.1 KB