Complete Our New Patient Form

At Inner Gate Acupuncture it is our goal to help each patient improve their quality of life and to achieve optimum health. Traditional Chinese medicine, which consists primarily of Acupuncture and Chinese Herbs, offers a unique approach to healing that nicely compliments other health care modalities. We work closely with physicians, alternative practitioners and you, our patient, in order to provide the best and most thorough treatment.

In order to serve you best we encourage you to fill out the form in as much detail as possible. Below, please either download a printable form (to bring with you when you come in for your first appointment) or complete an online form. Successful health care is only possible when the practitioner has a complete understanding of the patient physically, mentally and emotionally. All symptoms that you are experience are relevant and important to us as Chinese Medicine practitioners. All information will be held in strict confidence. Thank you.