New Patient Form

  • Services and Intention

    Chinese Medicine Works provides acupuncture and herbal remedies, along with counseling in nutrition and self-care, in a friendly environment. We expect to assist your body and you in a healing process. Welcome.

    We Request
    Please spend the time to fill out the Patient Information and Self-Assessment Health Profile forms. We know you are busy, but this information will assist us in serving you.

    Fees and Schedule
    The first appointment costs $200. Follow-up visits are $135 and last about 1 hour. Fees may be paid with cash, check, debit or credit card. We make every attempt to begin treatments on time and hope that you will too. Please leave sufficient time for travel and parking.

    Cancellation Policy
    We have reserved time and space just for you. If you wish to cancel your appointment, we require at least 48 business hours advance notification, or by 5:00 PM on Thursday for a Monday appointment. Late cancellations or missed appointments will be billed in full to your account.

    Let Us Know
    We want to know how to best meet your needs. Please inform us of any special considerations. We look forward to your visit and will do our best to be of service.
  • Date Format: MM slash DD slash YYYY
  • I understand that appointments not cancelled at least 48 business hours in advance, or by 5 PM on Thursday for a Monday appointment, will be billed to my account.