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I look forward to working with you to regain and maintain your optimal health and vitality. Suzanna Bliss MEd MAc LAc My own prescription for health is less paperwork and more running barefoot through the grass Leslie Grimutter As I see it every day you do one of two things build health or produce disease in yourself. Adelle Davis. All of your answers will be absolutely confidential. Address City State Zip Email Daytime Phone Evening Phone Occupation / Student / Retired Where Are you choose...
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First, gather all necessary information about your acupuncture experience.
02
Find the appropriate form or questionnaire to fill out.
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Enter your personal details such as name, date of birth, and contact information.
04
Specify whether you have had acupuncture or not by selecting the appropriate option.
05
If you have had acupuncture, provide additional details such as the date of the procedure, the clinic or practitioner's name, and any relevant medical history.
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Who needs have you had acupuncture?

01
Anyone who is considering acupuncture as a treatment option.
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Patients who have had acupuncture in the past and need to provide their treatment history for medical evaluation or research purposes.
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Healthcare professionals or researchers who are collecting data on acupuncture usage and its effects.
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Acupuncture is a form of alternative medicine in which thin needles are inserted into the body.
Individuals who have undergone acupuncture treatment are required to report it.
The individual must provide details of the acupuncture treatment received, including date, location, and reason for the treatment.
The purpose of reporting acupuncture treatment is to maintain accurate health records.
The individual must report details of the acupuncture treatment, including date, location, and reason for the treatment.
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