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David Lee Acupuncture
166 N. Moor park Road #201
Thousand Oaks, CA 91360
P: 805.497.6200 F: 805.497.6233
Date___PATIENT CONFIDENTIAL INFORMATION
Patient___
First Nameless Name Male(PLEASE PRINT)FemaleOther
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David Lee Acupuncture is in the field of alternative medicine that uses thin needles to stimulate specific points on the body to relieve pain and improve overall health.
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David Lee Acupuncture may be required to file by licensed acupuncturists operating their own practice or clinics.
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To fill out David Lee Acupuncture form, one must provide information on the practitioner, their practice, treatments performed, and any relevant patient information.
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Information such as patient name, date of treatment, type of treatment performed, and any relevant medical history must be reported on David Lee Acupuncture form.
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