Home | Acupuncture Clinic | Commonly Treated with Acupuncture | Contact

Required Forms:

Please fill out the following Required Forms and email or fax before your appointment to expedite your visit:

PRINT / FAX to 954-600-3878 (or bring with you to our office)
“New Patient Intake” Form (page 1)
“New Patient Intake” Form (page 2)
“Patient Introduction / Consent to Treat” Form (page 1-2)
"Our Financial Policies" (must complete last)

or COMPLETE ONLINE:
"New Patient Intake" Form (complete) (coming soon)
"Patient Introduction/Consent to Treat" Form (complete)
"Our Financial Policies"Form (must complete last)

Infertility Patient Forms:
“Infertility New Patient Intake”
“Infertility New Patient Intake page 2”
“Infertility New Patient Intake page 3”
“Patient Introduction / Consent to Treat” Form (page 1-2)
"Our Financial Policies" (must complete last)
Right To Privacy (Please print for your records)

 

serving Fort Lauderdale, Aventura, Hollywood and Miami areas with offices in:
Dania Beach, Plantation & Downtown Miami ~ call or email for appointment.
Patricia J Ahner, Licensed Acupuncturist ~ 954-600-3878 ~ pahner@healingx.org