Forms for New Clients (click here for download) 

Please print out and fill out the form, bring the completed form in your first visit.

We strongly recommend you to print out and fill out the form before you come to the clinic. In that way Dr. Xie can begin the evaluation as soon as you arrive at the clinic.

If you are not able to print out the form, you can fill out the PDF form in your computer with Adobe Acrobat Reader’s “Fill and Sign” function, then send the completed form via email to

  • info@acupunctureforhealthcare.com

  • Of course you can always choose to complete the form in our office. Please let us know and arrive 15 to 20 mins earlier than your appointment time if you need to do that. We will have the form ready when you arrive.