Our Forms

Dear friend,

Please read the Welcome letter first, as it provides essential information regarding how our clinic functions. You may wish to print this out for your reference.

Please print and fill out the Registration, Health History, Informed Consent and Financial Policy, and bring them with you to your first appointment. Community Supported Acupuncture depends upon your support. By helping us in this way, we have more time to focus on your health as opposed to shuffling papers. We are grateful for your participation in Community Supported Acupuncture.

Jordan and Serena

Downloadable Forms

Welcome to CommuniChi

CommuniChi Registration Form

CommuniChi Health History Questionnaire

CommuniChi Consent Form

CommuniChi Financial Policy

Please Note: The files above require the Adobe Reader. If you are unable to open them, you will need to download the free program here.

© 2007 CommuniChi. All Rights Reserved.

2524 16th Ave South, #301, Seattle, Wa, 98144 { Tel: 206.860.5009 }

Community Links:
Community Acupuncture Network | Working Class Acupuncture | Acupuncture without Borders
National Acupuncture Detox Association | Washington Acupuncture & Oriental Medicine Association | El Centro De La Raza

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