Please fill out these forms before coming in for your initial appointment. Your practitioner will go over your completed forms with you. Thank you in advance, as this will help make your first visit the best it can be!

"I have tried one other acupuncturist but Eastern Therapeutics is a relaxing, comfortable environment. I have been going here for over 1 year! I took a break for a couple of months and really noticed a difference. When I went back, I forgot how wonderful & relaxing the acupuncture was and I really feel that the acupuncture helps heal."    — Anonymous

Acupuncture - Health History 
(If you are coming in for fertility treatments, please fill this out instead: Fertility Questionnaire)

Consent to Receive Treatment

Cancellation Policy