Moss Acupuncture & Massage      The gold standard for acupuncture in Northeast Portland.

Please Bring a Completed Patient Medical History Form

to your initial appointment-- it will hasten the intake process

PLEASE DO NOT use double sided printing. Its a law, thanks.



Please download, complete and bring this
 
MEDICAL HISTORY FORM

 to your  initial visit.


If you have problems downloading this form

Or don't have access to a printer
 email me anytime at
 health@mossclinic.com

and I will be glad to email or mail them to you the old-fashioned way-- as long as you live near Portland, Oregon.

 

Your email needs to include your name and MAILING address, please.
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