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Acupuncture Intake Form

Download a free Acupuncture Intake Form template. Reduce wait room traffic and improve your documentation with this PDF.

Olivia Sayson avatar

By Olivia Sayson on Aug 2, 2025.

Fact Checked by Ericka Pingol.

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Acupuncture Intake Form Template

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Commonly asked questions

To comply with HIPAA, ensure the client intake form includes proper privacy disclaimers, such as a confidentiality notice. Store the completed forms securely, either in a password-protected digital format or in a locked physical space. Always obtain explicit consent for collecting and using personal health information, ensuring that the form only includes necessary data.

Yes, the Acupuncture Intake Form is a versatile tool. While it is crucial for the first session to gather comprehensive health history, it can also be used for ongoing treatment by adding sections to track progress, update health history, and document any changes in symptoms or client's goals. Updating the form regularly ensures the treatment plan remains aligned with the client's evolving needs.

If a client decides not to complete the intake form, it’s essential to address any concerns, explaining how the form ensures their safety and facilitates appropriate care. Make it clear that effective acupuncture treatment may be compromised without this information. If they still refuse, consider providing a simpler version or discussing alternative options to collect critical details during the appointment.

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