Skip to content

Clinic Forms

New Patients: Print and fill out this form to speed up the intake process during your first visit.

New Patient Health History Form (PDF, Adobe Reader required)


Insurance Verification Form (PDF, Adobe Reader required)


  • Please review the following to save your precious time and make your visit as pleasant as possible.

It is essential that you fill out all the above forms before coming to the clinic.

For the “Insurance Verification Form”, please call your insurance and follow the questionnaire. (Only applicable if you want to use your insurance)
* Please do not forget to write down the “Reference Number” at the end of the call.
** We are not in-network with Medicare or Medicaid. (Medicare Supplement or Secondary insurance may cover acupuncture)

Once you have filled out all the forms, please email them to and give us a call.

During the call, we will collect $20 as a deposit to secure your first insurance visit.
(If your insurance does not cover acupuncture, we will collect $150)

On your first visit, a health history intake and treatment will be performed. (Total time: 60-90 minutes)
Please wear or bring loose clothing. (T-shirt and shorts)

Follow-up visits are 30-60 minutes.

If you have any questions please feel free to contact us.

In Health,

Dr. Park Acupuncture