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Authentic Chinese Acupuncture Clinic Form

New Patients: Print and fill out this form to speed up the intake process during your first visit.

New Patient Registration Form
Arbitration Informed Consent Agreement Form
Women Fertility History Form (for fertility acupuncture only)
Auto Injury History Form (for auto injury acupuncture only)

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Logo Authentic Chinese Acupuncture Bellevue, Seattle, WA
Authentic Chinese Acupuncture

1370 116th Ave. NE, Suite 208
Bellevue, WA 98004
Contact us authentic Chinese Acupuncture Bellebue
Make appointment Authentic Chinese Acupuncture Bellevue, Seattle

hongpingren@gmail.com
www.authenticchineseacu.com
425-646-6888