Intake Forms

AKOYA ACUPUNCTURE
New York City • Langhorne, PA

Intake Forms

Please print and fill out one of the intake forms and the Informed Consent before your initial appointment.

If you are seeking relief from pain specifically involving muscles (i.e. sprains, strains, tennis elbow, stiff neck, etc.), please fill out the following form: Intake Form #1

For all other conditions, please fill out the following form:

Intake Form #2

All patients must bring the following form for the initial appointment. It includes the Informed Consent and an Advisory to Consult a Physician:

Informed Consent

Thank you!!

Akoya Acupuncture prides itself on being a paperless practice. All records and treatment notes are filed electronically and kept secure and confidential.

Disclaimer: The information contained in the website is not intended to diagnose, treat, prevent or cure any disease or syndrome. It should not be used as a substitute for appropriate medical treatment by a qualified practitioner.