Documents

Secure Patient Forms

Patient Intake Forms

Please download, complete, and upload all required forms before your first appointment with Pro Balance Acupuncture.

Step 1 — Download Your Forms

Please retrieve each required form below and save it to your device before completing it.

New Patient Form

Complete this intake form before your first visit.

Download Form

Informed Consent

Please review and sign this consent form before treatment.

Download Form

HIPAA Privacy Form

Please complete the required privacy acknowledgement form.

Download Form

Step 2 — Complete the Forms

  1. Open each PDF on your device.
  2. Fill out and sign all required forms.
  3. Save the completed files.
  4. Return to this page and upload them below.

Step 3 — Upload Completed Forms

Upload your completed PDFs directly from this page.

Enter your information and upload all three completed PDF forms.

A confirmation page will appear after submission.