Forms

Forms 2017-04-11T18:34:55+00:00

Client Registration Form

Download this PDF form, fill it out and bring it with you on your 1st visit.

 

Tatyanna Teeuwisse’s Hardship Agreement

Download this PDF agreement. Fill it out and bring it with you on your 1st visit to 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 1st visit to Tatyanna Teeuwisse, LAc.

 

Authorization to Release Medical Information

Only download this PDF form when instructed by your practitioner.

 

Acupuncture Pregnancy Intake Form

Download this intake PDF form, if you are pregnant. Fill it out and bring it with you on your 1st visit to Tatyanna Teeuwisse, LAc.

 

Progress Chart

Download this intake PDF chart if you like to track your progress of your sessions with Tatyanna Teeuwisse, LAc.

 

Consent to Treatment of Minors

Download this PDF consent form if you like Tatyanna Teeuwisse, LAc to treat a minor.