New Patient Paperwork

There are 4 forms below that must be completed before the first treatment.  They are health history and legal forms.

Completing these documents in advance will help shorten the time of the first office visit.  Typical office visits are about 1 hour, but the first visit requires a complete history and it can run up to 2 hours.   

Please bring the completed forms to your first appointment.

Any questions email chanta@newleafacu.com or call 920....

Patient Basic Info
File Size: 85 kb
File Type: pdf
Download File

New Patient Health History
File Size: 164 kb
File Type: pdf
Download File

HIPPA Consent
File Size: 108 kb
File Type: pdf
Download File

Financial Policy Acceptance
File Size: 67 kb
File Type: pdf
Download File

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www.newleafacu.com New Leaf Acupuncture & Herbal Medicine 7775 State Highway 42 Egg Harbor, WI 54212 Chanta Van Laanen, Licensed Acupuncturist Southern California University of Health Sciences alumn, www.scuhs.edu