Patient Forms

Covid Acknowledgment Form

In these trying times an extra consent regarding Covid is required of ALL patients.  Please fill out, print to your computer as a PDF with this format:  YourNameCovidConsent.  Make sure it is saved with content before closing.

Sheila Fay, LicAc CoVid Acknowledgment fillable

Acupuncture clients

Download, print & fill out the following three forms.red lamppost

Acupuncture Health history form

Consent to Treatment

HIPPA & Payment Policies – Balanced Life Healing

For Arvigo Abdominal Therapy

This form is fill-able online.  Once completed print as a PDF with this format: YourNameArvigoIntake.  Please make sure your information is saved before closing.

Arvigo Intake: History – enterable form