Patient Forms

New Patient Forms: Please print the Consent to Services and Intake Form prior to your first visit. We encourage you to fill out these forms in detail prior to your arrival so that we may begin your treatment promptly.  Our comprehensive Intake Form is designed to allow us to craft a detailed treatment plan specific to your needs. For your benefit, please complete this form entirely. Do not sign the Consent to Services form until you arrive in our office. Please review our HIPAA Privacy Statement prior to your first appointment. You may request that we print the HIPAA Privacy Statement. Please notify us prior to your arrival if you would like us to print this notice for your records.

New Patient Consent to Services

New Patient Intake Form

KMA HIPAA Notice for Patients

Financial Forms: Maryland law allows us to provide pre-payment discount packages for out of pocket medical services such as acupuncture and massage.  If you wish to take advantage of our pre-payment services, please print, read, and sign the following form prior to your arrival.  You will need to initial each paragraph to indicate that you understand the conditions of the package.

Prepaid Package Agreement


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