Acupuncture Intake Forms

You may download, print, and fill this form to save time when visiting the clinic.

Please note you will still need to sign the risk disclosure for prior to beginning your treatment. If you wish you can also download the risk disclosure form here.

The information on the web site does not constitute medical advice, and you should always consult your doctor for medical advice before taking any action to do with your health. By using this web site you agree to our terms and conditions of use.

Justin Hays, LAc, MAOM
(808) 387-9647

JL Hays