Intake Forms for New Patients

As a new patient to Acupuncture Northwest & Associates, please complete and bring the following items with you on your first visit. Fertility patients need to complete the fertility forms as well. Download and print the forms by clicking on the links below.

Traditional Chinese Medicine, Naturopathic Medicine and Massage Patients:

• New Patient Intake Form
• Your Insurance information or Card

Mind / Body (Counseling) Patients:

• Mind / Body Intake Form
• Your Insurance information or Card

Fertility Patients (Please also fill out these forms)

• Fertility Worksheet - Women's
• Fertility Worksheet - Men's

If you have any questions about completing the forms, please contact us, and we'll be glad to assist you.