Patient Intake Forms

Please download the form needed below and fill it in BEFORE your appointment.

Bring the completed form with you to your appointment.

  • Mary Dinneen – Chinese Medicine (Acupuncture, Acupressure) Intake form –to download it click here
  • Wendy Adaska – Medical Massage Therapy Intake from – to download it click here.
  • ATTENTION NEW PATIENTS: What You Need To Know Before Your First Appointment

    Hours are by appointment only. There are both day and evening appointments available. Please download our patient intake form above, fill this out and bring it to your first appointment.

    Your first appointment is a consultation. A review of your current health complaints, life style habits and health history will be assessed. Expect the appointment to last at least 1 hour. Upon completion of the consultation, you will be informed as to the time and cost investment that may be involved in treating your complaint.

    Your next appointment will be an acupuncture treatment, acupressure or a massage. These appointments last approximately 50 minutes. For your comfort, wear loose fitted clothing.—ie. Pant legs that can be pulled up past your knees.

    Payment (check/cash) is due following your appointment. Should you not be able to make your appointment, please give a 24 hour notice of your need to cancel. If this notice is not received a $25.00 rescheduling fee will be applied to your next appointment.
    *** PHS has the right to waive any fees ***