You may email completed forms to or bring a printed copy to your appointment.

Selby Acupuncture Intake Form

Use this form if you are coming for your first acupuncture or shiatsu massage visit.
Intake Form — Download PDF

Female Fertility Intake Form

Female fertility patients, please use this form.
Female Fertility Intake Form — Download PDF


Review our HIPAA (Health Insurance Portability and Accountability Act) Policy here:
Notice of Privacy Policies — Download PDF