HARMONY ACUPUNCTURE, LLC

Patient Forms

The following forms are designed to help us work together more easily:

Patient Intake Form

For new patient to fill in health information

Treatment Consent Form

This form needs to be signed before any treatment

Privacy Practice

HIPPA Privacy Protection Guidline

Information Disclosure Form

Form giving permission to release private information

Restriction Form

Form of restricting patient information from being realeased

NADA Treatment Consent Form

This form needs to be signed before 5-needle NADA treatment

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