July 7, 2016 303.669.4529info@pure-acupuncture-denver.com Chinese Medicine & Acupuncture in the Highlands Jefferson Park Area


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Please download the forms on the links below and fill out prior to your appointment. You will not need all of the forms, so please read below to bring the correct one to your session.

All New Adult Patients will need the Intake & Disclosure Forms.

For Pediatric patients, please bring in the Pediatric Intake & the Disclosure Form.

For NAET Patients, please bring in the Intake (for adults), the Pediatric Intake (for kids under 12), the Disclosure Form AND please print out the Instruction to NAET patients form. This form is for your information only, but it is very important to prepare yourself for treatment, so please have a read.  

Thank you!

Acupuncture Intake

Disclosure Form


Patient Pediatric Intake

Instruction to the NAET® Patient before beginning NAET® Treatments

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