Patient Intern Clinic Forms
Click on a form name to begin. If you can fill in the online form, great!
You may also download the forms in PDF format and bring them with you for your initial visit. We have printed forms available in the office if you prefer to fill them in there.
Advisory to Consult Form
PERMISSION TO TREAT
Clinic Intake Form
YOUR HEALTH
Informed Consent Form
UNDERSTANDING YOUR RIGHTS
Health Insurance Portability and Accountability Act (HIPAA)
PATIENT RIGHTS TO PRIVACY
Download for your records
Lateness/Cancellation & Parking Policy Form
Office Policies
Privacy
Policy Form
UNDERSTANDING YOUR PRIVACY
How You Can Heal
Your Life For Good
Compassionate acupuncture and TCM services are offered at low cost, making a wellness approach accessible to all patients.
Serving the Community
A vital part of the Eastern School of Acupuncture and Traditional Medicine’s mission is to serve the community, and we accomplish this within our Intern Clinic. Fees are affordable, and the patients receive superior care. Under the guidance of the College’s Licensed Clinical Supervisors, interns treat a wide variety of conditions.
Guided by skilled clinicians
Fees are affordable, and patients receive superior care.
Customized Medicine
Comprehensive TCM sessions tailored to your health concerns, promoting harmony and long-term well-being.