Four Winds Acupuncture

Please call to make an appointment before filling out this form.

Tel: 386-677-5400


We consider it our greatest priority to provide a comfortable and healing environment for our patients. All answers are strictly confidential and will only be used to create the best form of care. Please complete this document as thoroughly as possible. Some of the questions that follow may seem unrelated to your condition, but may play a significant role in your diagnosis and treatment.

Thank you!



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