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Patient Forms

Patient Forms

Welcome Letter and Treatment Tips

New Patient Form

Insurance Authorization and Billing

Pediatric Intake Form (0-13 Years Old)

Consent for Cosmetic Acupuncture

Cosmetic Acupuncture Intake Form

HIPAA Notice

COVID Consent for Treatment

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Photo: Jeffrey R. Schwartz

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Visit our two convenient locations:

23 Shoreham Drive West, Dix Hills NY 11746

510 Hempstead Turnpike, Suite 208, Cherry Valley Shopping Center, West Hempstead, NY 11552

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© 2021 Dix Hills Family Acupuncture

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