(919) 621-3363
Pointing you to a healthier and more natural way of living

Forms

Please download our forms for your use. You will need Adobe Acrobat Reader to open these files.

Acupuncture and Herbal Patient Forms

Patient HHQ Form
Consent to Treatment Form
Office and Financial Policy
Notice of Privacy Practices

Pediatric Patient Forms
Fill out only if specified by practitioner – for children younger than six years old.

Pediatric HHQ Form
Pediatric Consent and Office Policy
Notice of Privacy Practices

Quit Smoking Program

Smoking Cessation HHQ Form
Consent to Treatment Form
Office and Financial Policy
Notice of Privacy Practices