Lotus Room
These forms are designed to be printed from Adobe Acrobat. If you don’t have Adobe Acrobat, a free version of Acrobat Reader is available here.
Please print these out, complete the questionnaire, read the Notice of Privacy Practices and Informed Consent form, which includes a description of therapeutic modalities, and sign and date the latter prior to your first office visit.
Forms for patients of Matthew P. Sieradski, L.Ac.:
Intake Questionnaire
Forms for patients of Alicia Derby, L.Ac., D.A.O.M.:
Intake Questionnaire
Gingko Room
Forms for patients of Matthew M. Branham, L.Ac.:
Intake Questionnaire
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