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Chinese Medicine for the Entire Family.
Below are links to forms that can be reviewed and printed out online for people coming in for treatment. These forms are not necessary for veterinary patients. If possible, please review, and fill them out before your first visit. If you have questions, please call Dr. Fochios at 828 254-2773 or 828-380-9747. If you cannot print out these forms, please arrive about 25 minutes prior to your appointment to fill out the required paperwork. Thank you.
ACUPUNCTURE PATIENT MEDICAL FORM
Please print out this detailed medical history form. Completely fill it out, and bring it with you to your first appointment.
| NOTICE OF PRIVACY POLICIES (HIPPA)Information for your files |
| ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICESPeople and Pets Acupuncture provides each patient with a statement of Privacy Policies |
| CONTACT INFORMATIONThis information will allow us to keep in touch with you when necessary. |
| PEOPLE AND PETS ACUPUNCTURE CONSENT TO TREATMENT FORMThis form gives the licensed oriental medicine practitioner permission to treat the patient. |
| PATIENT CONSENT FOR THE PURPOSES OF TREATMENT, PAYMENT AND HEALTHCARE OPERATIONSPeople and Pets Acupuncture maintains health records describing health history relevant to overall care and treatment. |
| PATIENT CONTACT INFORMATION This form provides physician and emergency information as needed. |
| ARBITRATION AGREEMENT FORM SIDE 1Arbitration Agreement |
| ARBITRATION AGREEMENT FORM SIDE 2Arbitration Agreement |
DrAndrea@PeopleandPetsAcupunture.com