Forms and Agreements for Clients

Forms for all practitioners

• Client Registration Form
  Download this PDF form, fill it out and bring it with you on your 1^st visit.
• Financial Hardship Agreement
  Please call the office before downloading this PDF form.
• Authorization to Release Medical Information
  Only download this PDF form when instructed by your practitioner.

Forms for Tatyanna Teeuwisse, LAc

• Acupuncture Intake Form
  Download this intake PDF form, unless you are pregnant. Fill it out and bring it with you on your 1^st visit to Tatyanna Teeuwisse, licensed acupuncturist.
• Tatyanna Teeuwisse's Hardship Agreement
  Download this PDF agreement. Fill it out and bring it with you on your 1^st visit to Tatyanna Teeuwisse, licensed acupuncturist.
• Acupuncture Pregnancy Intake Form
  Download this intake PDF form, if you are pregnant. Fill it out and bring it with you on your 1^st visit to Tatyanna Teeuwisse, licensed acupuncturist.

Forms for Dr. Julie Esterly, DC

• Julie's Intake Form
  Download this intake PDF form, fill it out and bring it with you on your 1^st visit to Julie Esterly, Doctor of Chiropractic.
• Julie's Automobile and Job Injury Form
  Only download this automobile and job injury PDF form when directed to do so. Please fill it out and bring it with you on your 1^st visit to Julie Esterly, Doctor of Chiropractic.

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Our documents can be filled out electronically and then printed; making light work of paperwork.