This form can be printed on your printer and filled out before your first appointment to save time. Please bring this with you to your appointment. Do not e-mail.
Press button to Download Form
in PDF format below.
* It is good to have something to eat about an hour before your treatment.
* Wear comfortable clothes that allow access to areas below the elbows and knees.
* We ask that you please refrain from wearing any perfumes, scented lotions or oils to your appointment.
* Please turn your cell phones off or silent when entering the treatment room.
* If possible, set aside time after your treatment to rest.
* Payments are due at the time of service. We currently accept cash, check or credit/debit/health savings cards.
* Cancellations: Kindly give 24 hour notice if you are unable to make your appointment.
* There will be a fee of $60 for missed (no show) appointments or same day cancellations. I respect your time. Please be respectful of mine as well. Thank you.
* For your privacy, please do not e-mail or
text your personal health information.
Sunflower Community Acupuncture
for appointments; call 720.684.8865
or email using the link below.