Natural Bridge Acupuncture
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Please Fill Out These Forms

Before your first appointment, please fill out these forms.

Forms for your initial private appointment.


​If you are a new patient, please download and print the following forms for your private appointment.  Fill them out and bring them to your initial consultation.  

If you are unable to print the forms, they will be available at the clinic. Please come in 30 minutes early to fill them out.   

HEALTH HISTORY - INITIAL APPOINTMENT
Concent to Receive Treatment Form
Consent Form for Purpose of Treatment (HIPPA)
Your Health Information and Privcy

415 Natural Bridge Rd.  Slade, KY 40376
office:  (859) 404-1653
email:  naturalbridgeacu@gmail.com
  • Welcome
  • Services
  • Forms
  • Appointments and Rates
  • Resources