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Intake Forms

These are PDF files and should easily download and open on any computer. Press the link below to open the file on your computer. We appreciate your taking the time to fill out this extensive form so that we may understand your situation more fully and spend more time speaking with you directly and formulating a treatment plan when you come in for your first visit.

Note: Download the Consent and Insurance Forms for adults and children alike.

We look forward to working with you!

1. Adults

2. Children (below 9)

3. Consent and Insurance Forms (signature required)

Other forms:

4. Reassesment Form

5. Traveler's Intake Form

 

Ten thousand flowers in spring,
the moon in autumn,
A cool breeze in summer,
snow in winter -
If your mind is not clouded by unnecessary things,
this is the best season of your life.

-Wu-Men,
Chinese Poet

Ashland Acupuncture
541.488.9696
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