(267) 968-1479  reliefacupuncturepa@gmail.com

Forms

For your convenience, we encourage patients to complete the health history forms provided here before your appointment. These forms will be sent directly to Faith for her review prior to your first meeting. All information is confidential.

* Please note that if you are viewing on iPad or iPhone, you will need Adobe Reader installed firsthttps://itunes.apple.com/us/app/adobe-acrobat-reader/id469337564?mt=8
When viewing on iPad or iPhone, make sure you “Open In – Adobe Acrobat” once Adobe reader is installed:
Adobe Acrobat iOS

Download, complete, and send:

Please fill in all relevant fields and click the red button on the bottom of the last page to email it to us.  Or you can bring the printed out form to your appointment.
If emailing, don’t forget to attach the PDF to your email!

Feel free to call 267-968-1479 or email us if you have any questions or concerns.