Intake Forms

If you have an appointment with Tony Burris, L.Ac., please print and complete ALL of the following three documents to bring with you to your first appointment:

1.) Tony Initial Health History Form

2.) Stress Assessment Form

3.) Notice of Privacy Practices and Patient Agreement

If you have an appointment with Kristen Burris, L.Ac., please print and complete the following two forms to bring with you to your first appointment:

1.) Kristen Initial Health History Form

2.) 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.)