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Forms

Acupuncture Intake Form:

This can be done at the time of your initial acupuncture session or you can fill it out and bring it with you.

 Acupuncture Intake Form (.pdf document)

 

Counseling Intake Forms for Zen Life Wellness:

Below are the forms for new Zen Life Wellness Community clients.  Clients seeing therapists through Maryland Modern Family (Bess Hauf) or Hygeia Counseling (Michael Reeder) should ask those providers for the proper background forms.  Much of the information required for Zen Life counseling sessions (such as demographics and credit card information) is collected online during the scheduling process.

Adult Intake Background Form (.pdf document)

Consent for Treatment (.pdf document)

Release of Information Form (.pdf document. Only used if there is a doctor or therapist to get old records from or consult with.)

Alpha-Stim Cranial Electrotherapy Stimulation Consent Form (.pdf document.  Only needed if you are engaging in the optional additional Alpha-Stim treatment.)