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Patient Name: Date: Acupuncturist: Terry Fox, L. Ac., Clinic: Artesian Spring Oriental Medicine, Consent: I hereby request and consent to Cosmetic Acupuncture treatment by the acupuncturist named
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Begin by gathering all the necessary information and documents required to fill out the form.
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Start by entering your personal details such as your name, address, contact information, and date of birth.
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Provide your medical history, including any previous acupuncture treatments or other relevant medical conditions.
04
Specify the reason for seeking acupuncture from Terry Fox L and describe any specific symptoms or concerns you have.
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Those interested in alternative or complementary medicine approaches to healthcare may seek the services of Terry Fox L.
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It is advisable to consult with Terry Fox L or a healthcare professional to determine if acupuncture is an appropriate treatment option for specific health concerns.
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