Intake Forms

Are you coming for your first acupuncture or shiatsu massage visit? Click below to download our intake form. You may e-mail the completed form to or bring a printed copy to your appointment.

Selby Acupuncture Intake Form

Female fertility patients, please use this form:

Selby Acupuncture Female Fertility Intake Form

Review our HIPAA (Health Insurance Portability and Accountability Act) Policy here:

Notice of Privacy Policies