Acupuncture • Shiatsu • Chinese Herbs
Energy Healing

  
 

Patient Forms
   
 


Please print all three of the documents below,
complete them, and bring them with you to your appointment.

Thanks!

Health History Questionaire

HIPA

Consent to Treatment

 

 
 
  
 

Hayley Mermelstein • 800 Main Street, Amherst, MA 01002 • 413.253.7978

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