Dusty Foot Acupuncture Clinic

Confidential Information/Patient Consent Form

If you're a first-time client, please print this form, complete it, and bring it along to our first session

Disclaimer Form

If you're a first-time client, please print this form, complete it, and bring it along to our first session

Acknowledgement Form

If you're a first-time client, please print this form, complete it, and bring it along to our first session

Medical History Questionnaire

If you're a first-time client, please print this form, complete it, and bring it along to our first session

Insurance Verification Form

If you plan on using insurance and you're a first-time client, please print this form, complete it, and bring it along to our first session

History of Injury Form

If you were injuried in an auto accident and you're a first-time client, please print this form, complete it, and bring it along to our first session

Intended Outcomes Form

This form will help you clarify your goals for your overall health and vitality, including our time together.