Pro Natural Health Center 医本堂
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  • What Acupuncture Treats
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  • Rhythmic Cupping Therapy
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  • Moxibustion (Moxa) 艾灸
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Photo Gallery - US
Photo Gallery - Others
Pro Natural Health Center 医本堂
Home
About Us
Forms
Testimonials
FAQ
  • What Acupuncture Treats
  • Cupping
  • Rhythmic Cupping Therapy
  • Qi Gong and Tai Chi
  • Moxibustion (Moxa) 艾灸
Photo Gallery - China
Photo Gallery - US
Photo Gallery - Others
More
  • Home
  • About Us
  • Forms
  • Testimonials
  • FAQ
    • What Acupuncture Treats
    • Cupping
    • Rhythmic Cupping Therapy
    • Qi Gong and Tai Chi
    • Moxibustion (Moxa) 艾灸
  • Photo Gallery - China
  • Photo Gallery - US
  • Photo Gallery - Others
  • Home
  • About Us
  • Forms
  • Testimonials
  • FAQ
    • What Acupuncture Treats
    • Cupping
    • Rhythmic Cupping Therapy
    • Qi Gong and Tai Chi
    • Moxibustion (Moxa) 艾灸
  • Photo Gallery - China
  • Photo Gallery - US
  • Photo Gallery - Others

New Patient Intake Forms

Please send SENSITIVE notes, documents & forms to the following SECURE email address (HIPAA compliant):

 https://sendsafe.to/pronaturalhealth.ctr@gmail.com

1 New Patient Registration & Health Condition (pdf)Download
2 Notice Of Privacy Policy (pdf)Download
3 AAC Informed Consent (must be in COLOR if printed) (pdf)Download
4 Assignment of Benefits (pdf)Download

COVID-19, Cold & Flu Screening Q&A

Covid, Cold & Flu screening Q&A (pdf)Download

Other Forms

AUTO ACCIDENT QUESTIONNAIRE (pdf)Download

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