15644 Pomerado Rd., Suite 102    Poway, CA 92064

New Patient Acupuncture and Herbal Form

Acusimple Online Patient Portal and Practice Management Software for Acupuncturists

Please Log in to the Patient Portal and fill out the Intake Form and Consent, and the System Contact form.  There are forms for all new patients.

These are required forms in order to receive acupuncture and herbal care at our office. All forms are CONFIDENTIAL. Please fill it out as completely as possible even if you do not feel certain questions pertain to you. It is designed to be as thorough as possible.

Privacy is important, and your information will not be shared.  We use HIPPA compliant secure software.

*For a new user to our Patient Portal, you would Choose, “Create New Account”.