Unique Combination of Acupuncture,
Herbs, Bioelectrical Medicine,
Cortisone Injection, Physical Therapy
- Acne
- Insomnia
- Allergies
- Bell's Palsy
- Chronic Pain
- Constipation
- Diabetes
- Dizziness
- Impotence's
- Menopause/PMS
- Obesity
- Quit Smoking
- Stress
- Stroke
- All types of Chronic Illness
- Weight Loss...and more!
Our Staff Speaks Chinese, Japanese & Spanish
112 N. Riverside Ave., Rialto CA 92379 phone: 909-875-1212 Fax: 909-498-7361
Home | About Us | Accupuncture | Pain | Weight Control | E-mail Us
PATIENT REGISTRATION FORMS:
Registration Form
– For all patients
Patient History Questionnaire
– For all patients
HIPPA
– For all patients
Pain Management Agreement
– For patients who need pain medications or class III medications
Notice of Doctor’s Lien
– For personal injury patients
Acupuncture Consent
– For patients who need acupuncture treatment
To save your time, please fill all the forms that pertain to you. Please print and bring the signed forms to our office.
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