forms and documents
As with your first visit to most medical offices, there is some paperwork to be filled out. Please feel free to print these, fill them out at your convenience, and bring them with you to your first appointment.
Microsoft Word:
HIPAA Notice (This is for your information only. You do not need to bring this with you.)
PDF: If you are a new patient, please print and complete both of the documents below and bring them to your appointment.
Patient Health History Questionnaire (There may be pages intentionally left blank for the purposes of printing this document double sided)
If you are coming only for a free consultation, and have not yet decided to proceed with treatment, you need only this very simple one page form:
For Our Patients
Please note that masks are REQUIRED for patient’s safety while in the office. Thank you.
Hours by Appointment
- Call Today 603.589.9805
- Alternating Sundays: 9:20 – 2:00 PM
- Monday: 8:20 – 5:00 PM
- Tuesday: 12:00 – 7:00 PM
- Wednesday: 8:20 – 2:20 PM
- Thursday : 12:00 – 7:00 PM
- Alternating Fridays: 9:00-4:00 PM
- Closed on Saturday
Credentials
- Licensed Acupuncturist in NH
- Certified in BLS
- Governor Appointed to the OPLC Board of Acupuncture Licensing since 2020
- NCCAOM Certified as a Diplomate in Acupuncture

- Past President for NH Acupuncture and Asian Medicine Association
