New Patient Forms
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Welcome to our Cincinnati acupuncture clinic.

 

For your convenience, we accept Visa, Master Card, Discover and American Express.

Please print and fill out the following 5 forms and bring them with you to your scheduled appointment. 

  • Patient Information Sheet

    Please fill out the form.  Sign where is requested.  At the bottom of the form please indicate up to 2 people (not including your physicians) to whom we are authorized to discuss your medical information with and sign.  If there is not one that you authorize, just write "NO ONE", sign and date.

  • Patient History Form and Pain Assessment Chart

    Fill out the forms regarding your medical history as thorough as possible. At the front of the page, please indicate your reason to see Dr. Sheng under Reason Visiting this Office.

    If you have no pain, please note "No Pain" on the Pain Assessment Chart and sign at the bottom of the form.

  • Fee Policy

    Please read the policy, sign and date where it applies to your visit.  Patients who have not been seen by Dr. Sheng for more than three years are considered new patients and will be charged accordingly.

  • Notice to Privacy Practice & Acknowledge Form

    The first page is regarding the privacy practice we adopt in this practice.  This is for you to keep.

    On the second page, please fill out your name, sign and date and bring this with you to your appointment.  This form indicates your acknowledgment of the privacy practice.

Preparation

  • Wear comfortable and loose fitting clothes.
  • Do not eat a large meal before you come.
  • Do not come in a hurry.
  • Bring your own relaxing music.
  • Come with calm spirits and a happy mood.
  • Do not exert yourself after the treatments

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