Forms

Client Registration Form
Download this PDF form, fill it out and bring it with you on your 1^stvisit.

Hardship Agreement
Download this PDF agreement. Fill it out and bring it with you on your 1^stvisit.

Acupuncture Intake Form
Download this intake PDF form, unless you are pregnant. Fill it out and bring it with you on your 1^stvisit.

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 1^stvisit.

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.