New Patient Forms

Fill in Your Details

The listed forms are for New Patients regardless of diagnosis or health issues needing Beth’s assistance.

Each New Patient needs to complete both the New Patient Forms and a Medical History. Select the tab below as appropriate for your age group. The Adult selection has the forms for patients 18 and older, and the Child selection has the forms needed for patients under 18 years old or who have a legal guardian. All files are in PDF format.

Please select the age-appropriate forms for each patient who is to see Beth and print it.

Please fill out and sign all forms ahead of time and bring them to your first scheduled appointment.

While Beth will explain as much as she can about the energy system while she is working with you, you will receive greater benefit during your first appointment if you take time to read the information pages about the energy systemacupuncture , and the allergy protocols. Feel free to take notes and ask Beth questions about what you read.