New Patients


Michael Domeny DNP-c, FNP, MS, L.Ac, CD/N,

Licensed Nutritionist, Licensed Acupuncturist

Board certified Herbalist,

Family Nurse Practitioner



Acupuncture Forms


General

  Please complete this Acupuncture Assessment form and submit it at least one day prior to your visit.  Doing so allows for better time efficiency.

 

Neck & Shoulder

  Patients inquiring about the treatment of Neck & Shoulder, please complete also this quick screening form.Neck & Shoulder Assessment form

         


Nutrition 


     If you are scheduling general nutrition session or session for weight loss, please complete the following form Nutrition Assessment Form  


 

 

Thank you for your cooperation 

 

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