Book an appointment with Trinity Acupuncture & Wellness using SetMore

Forms

Hello and Welcome to our Practice.

We want you to know we appreciate the chance to take care of you and your family. Trinity Acupuncture and Wellness provides integrative therapies and/or referrals to other medical professionals in helping you achieve your health goals. Our Practice is focused on providing you with a broader view to healing through assessment, education and a personalized treatment plan.

During your first visit Cassandra Wind, MT Licensed acupuncturist, will review your full medical history. Please bring with you any supplements and medications you are currently taking. (Please bring along all bottles/containers to the appointment as well)

We ask that you allot 75 minutes for this first appointment. Your full medical history will be discussed and a physical assessment completed. You will have the opportunity to try an acupuncture needle during this appointment.  Our policy for new patients is that if you miss your first scheduled appointment, any future new patient appointments must be pre-paid.

If you are in need of ongoing treatment, a treatment plan will be recommended based on your health goals. You will have the chance to review the recommended treatment plan and ask any questions that you may have.

Below you will find a health history form and questionnaire. Please fill them out entirely (8 pages in total) and bring them with you to your appointment. While our services are not typically covered by major health insurers, if you have a Flex Spending account with your insurance provider you are able to use that with us.

Thank you for choosing our Practice and we are looking forward to meeting you.

Sincerely,
Cassandra Wind, LAc.

 

New Patient Health History

Please set aside 30 minutes to complete and bring this form to your first appointment.

Note: To download Adobe Acrobat Reader for free, click here.