Acupuncture Alexandria LLC

New Patient Paperwork

Welcome to my practice! You have taken an important step on the road to more vibrant health. I look forward to helping you with any health concerns you may have.  

 

Please Read Over the Acupuncture Consent To Treatment and HIPPA Privacy Policy.  You will be asked to sign a confirmation that you read and understood them in the paperwork.  If you would like a printed copy I will be happy to provide you one at your appointment.

 

 

You can choose whichever option below is easiest for you to fill out paperwork

 

 

Option 1: You can log into the patient portal to fill out and sign the forms online.  You may have to update your password when you login the first time.  

 

Please fill out three forms: Health History Basic, Acupuncture Consent Forms, and Virginia Form

 

For my Alexandria office log in here

 

For my Burke office log in here

 

 

Option 2: You can print out the forms and bring them with you to your appointment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Option 3: You can arrive 10-15min early for your appointment and fill them out in the office.

 

 

If you have any questions or concerns before you're appointment please call or email me at the information below.  I look forward to seeing you at your upcoming visit.  

 

Sarah Shupe Hung L.Ac.

Acupuncture health history Consent Form Recommendation for Examination by Physician