Proactive Wellness Partners offers our patient forms online so you may complete your form(s) in the convenience of your own home or office. The Acupuncture Referral form must by completed by your Physician before you can receive any acupuncture treatments.

Download the necessary form(s) located below, print it out and fill in the required information. You may fax us your completed form(s) or bring it with you to your scheduled appointment.

New Patient INTAKE & Health History Form and PHYSICIAN ACUPUNCTURE REFERRAL Form – Required

This helps establish you as a patient in the clinic. The second part of the form lets us know the history and current state of your health as well as what questions, concerns, and goals regarding acupuncture can we help you with. Let us know! The more information you provide us, the better we will be able to assess your health concerns and create the best treatment plan for you! Please fill out these forms before your first visit, as it will make the visit go smoother with less wait time.