White Crane Community Acupuncture
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Intake & Consent Forms


acup_intake_form.pdf
File Size: 610 kb
File Type: pdf
Download File

New Patient Intake Form
​Please print and fill out this document to bring with you

acup_inform_consent.pdf
File Size: 388 kb
File Type: pdf
Download File

New Patient Consent Form
​​Please print and fill out this document to bring with you


By Appointment Only
James A. Sears, MSOM, LAc

42 E Rahn Rd #102
Dayton, OH 45429
937-361-5738 (Please leave a message if calling)
Email Us (Please provide a phone number for contact)

​Copyright 2017, White Crane Community Acupuncture
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  • Home
  • Services and Pricing
  • About Acupuncture
  • Practitioner
  • Forms
  • Specials