Patient Forms (For American Specialty Health)
If your health insurance provides coverage for Acupuncture treatments through American Specialty Health, please download the following health history form and bring the completed form to the initial visit:
- ASH Patient Health History Adobe Acrobat format (.pdf)
If you are unable to download and print out this form then you will need to come to the office 15 minutes before your scheduled appointment. Please call 805 403 2188 if you have any questions regarding the form.
You may also wish to review our Notice of privacy practices, which describes how we protect your health information:
- Notice-of-privacy-practices Adobe Acrobat format (.pdf)