Online Forms

Bennett Acupuncture offers our patient forms online so you may complete your form(s) in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download the software.
  • Download the necessary form(s) located below, print it out and fill in the required information.
  • You may fax us your completed form(s) or bring it with you to your scheduled appointment.

New Patient Initial Visit & Health History Forms – Required

This helps establish you as a patient in the clinic. The second part of the form lets us know the history and current state of your health as well as what questions, concerns, and goals regarding acupuncture can we help you with. Let us know! The more information you provide us, the better we will be able to assess your health concerns and create the best treatment plan for you! Please fill out these forms before your first visit, as it will make the visit go smoother with less wait time.

Download & print form: NEW-PATIENT-QUESTIONNAIRE-FORM v2 2018
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Member Wellness Registration Form – Optional

If you are interested in becoming a member of our Bennett Acupuncture website, please print and fill out this form. Once completed and returned to us, you will have access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues, news and events in our office. The form is available below to be printed, filled out and returned to our office. The online newsletter sign-up is also located on the right of this page. We look forward to making your experience with our office and website more interactive and rewarding!


Download & Print Form