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Forms

Patient Forms

The following forms must be read and signed prior to your treatment.
 

The intake form will require some time to fill out and provide ample detail.  Please do your best to provide as much detail as possible.  This form can be filled electronically or printed and filled manually.  To fill this form electronically, Adobe or Foxit PDF viewers are recommended.

Family Acupuncture and Holistic Medicine

Family Acupuncture & Holistic Medicine is a natural and holistic medical practice serving the greater Boston area, southern Maine, and Portsmouth, New Hampshire. We treat the whole person through acupuncture, herbs, moxibustion, diet, and supplements. 

©2021 by Family Acupuncture & Holistic Medicine. All rights reserved.

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