Forms & Policies

Please complete these forms and bring them to your first appointment:

New Patient Intake Form

Patient Medical History Form

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Please read the following form before your first visit:

HIPAA Privacy Policies Form (not required to print)

For Microneedling patients, please complete and bring the following to your first treatment

For injection therapy patients, please review this document:

Informed Consent Injection/Intradermals (not required to print)

Rates

First Visit/Consultation $125 (New Patient Special $75)

Follow up visit(s) $70

Children (under 12) $60 first visit, $40 follow up

Prepayment of 5 or more acupuncture treatments *Save 10%*

B-12 Shots $20

Traumeel injections $30 each

Collagen facial injections $40-60 based on area treated

Chinese Herbal Medicine Sold Separately

Payment Policy

Payment for services rendered is expected at the end of each visit. Acceptable forms of payment are cash, personal check or Visa / MasterCard. There will be a $25 charge for returned checks. Insurance can be billed on a case by case basis for auto accidents or group health benefits with a doctor’s referral.

Cancellation Policy

Your appointment time has been reserved specially for you. Failure to show up for your appointment robs others the opportunity to receive needed treatment. If you wish to cancel your appointment, we request 24 hours notice to allow other patients to schedule if necessary. If you fail to arrive to your appointment and do not notify us, we will add $25 to your next appointment. We regret that patients who repeatedly cancel or fail to show up for appointments will be referred elsewhere for treatment.

(303) 934-3753