Consultation
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New Patient Form – Acupuncture
Fill out and submit the form online via secure internet connection.
Alternately, the completed form can be faxed to: 416-929-6365.
*It is important that you provide your accurate email address and reachable phone numbers so that we can contact you promptly.
Acupuncture Secure Online Form
Acupuncture form (PDF)
New Patient Form – Massage, Shiatsu, Reflexology
Please bring the completed form with you at your first visit. The form can also be faxed to: 416-929-6365.
Massage form (PDF)
Supplemental Forms
Kampo Constitutional Evaluation Form Online SSL Kampo Form