Acuharmony & Wellness Acupuncture and Healing Center

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Call us for an appointment

850.476.3700

Beauty is Health
Made Visible

Acupuncture

Be prepared to stay for 1 hour and 30 minutes for your first visit.  This intake will include an initial consultation, diagnosis, and a balancing treatment. Most future visits will last for approximately 50 minutes to 1 hour.

 

Click on and print the following form. Print on one side only. Please take the time to answer all questions carefully and thoughtfully, and bring them with you to your first visit.  Your answers will help me to serve you to the best of my ability.

 

Intake and Consent Form

 

Things to consider before arriving for treatment

  • Make sure to eat something light an hour or two before arriving
  • Try to avoid the intake of caffeine or pain medications
  • Wear loose fitting clothes which allow access from knees to toes and elbows to fingertips
  • Bring a list of medications you are taking
  • Do not eat anything that stains your mouth or tongue for the visit
  • It is preferable that you do not wear any makeup on your skin
  • Eye makeup is OK
  • Remember to fill out your intake forms and bring them to your first appointment

 

Privacy Practices

This form is for your information only.  It is not necessary to print a copy unless you would like one for your records.

 

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