Forms
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There are several forms to fill out the first time you come in for a treatment. While you can simply fill these out in the office, you can save time by downloading the forms, printing them out, filling them in at your leisure, and then bring them with you to your first session. This page links to PDF-versions of these forms. By right-clicking on the link, you can download the file to your computer directly.
The PDF-files require Adobe Reader. If you don't have Adobe Reader, you can download it for free from Adobe.
Intake Form
This form is a complete overview of your current condition. It includes personal and family history, and a detailed overview of your current symptoms. All symptoms (even ones seemingly unrelated to your chief complaint) are part of the diagnosis in Oriental Medicine.
Physican Evaluation Form
In Texas you are required to have been seen by a physician or a chiropractor previous to seeing an acupuncturist, with a few exceptions. This form lets us know that you have done so, and your signature indicates that this is the case.
Informed Consent Form
This form tells you about what you can expect from your Oriental Medicine treatment.
Privacy Policies Form
This form explains our privacy policies at Jade Blossom Acupuncture, and informs you of your rights concerning the privacy of your health data. The Federal HIPAA law (Health Insurance Portability and Accountability Act) covers all health care providers, and this form is our version of the standard forms that you fill out when you go to a new doctor or chiropractor.
Client Agreement Form
This form details clinic policies, and lets you know what we expect from you when you come in for a treatment. It includes information about timely notice of cancellations, our cell phone policy, and other important policies.