You may email completed forms to info@selbyacupuncture.com 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

HIPAA

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