Eagle Acupuncture, Meridian and Boise: Tony Burris and Kristen Burris » Intake Forms

Intake Forms

If you have an appointment with Tony Burris, L.Ac., please print and complete ALL of the following four documents to bring with you to your first appointment. Please print these forms out on the front side of each piece of paper only:

1.) What To Expect On Your Visit With Tony Burris, L.Ac.

2.) Initial Health History Form for Tony Burris, L.Ac.

3.) General Pain Index Questionnaire (Please Fill Out If You Are Coming In for Pain Management)

4.) Notice of Privacy Practices and Patient Agreement

5.) Please Read and Understand If You Plan On Using Health Insurance

If you have an appointment with Kristen Burris, L.Ac., please print and complete the following five forms to bring with you to your first appointment. Please print these forms out on the front side of each piece of paper only:

1.) Initial Health History Form for Kristen Burris, L.Ac.

2.) Cancellation Policy Form for Kristen Burris, L.Ac.

3.) Stress Assessment Form

4.) Detoxification Questionnaire Form

5.) Notice of Privacy Practices and Patient Agreement

 

Other Forms:

Nutrition Diary (Print only if you have made an appointment for a nutritional consult.)

Tai Chi and Qi Gong Waiver (Print only if you are signing up for the tai chi, qi gong or meditation classes.)