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)

New Patient Intake Forms

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:

Free Consultation Questions

For Our Patients

Please note that masks are REQUIRED for patient’s safety while in the office. Thank you.

Hours by Appointment


OPLC Logo Acupuncture Center of Southern New Hampshire Nashua

Click below to receive our monthly Newsletter