In order to allow maximum treatment time during your first visit, please print and complete these five forms. Scan and email them to or send them by postal service to:

Janet Cook

8303 Shoal Creek Boulevard

Austin, TX 78757

Alternatively, bring them to your first session.

Call at 512-826-1164 or email if you have any questions.

3 Notification of Privacy Policies (two pages)

4 Patient Intake Forms (four pages)

5 New Patient Information and HIPPA Acknowledgment

1 Notice of Evaluation of Patient by Physician

New Patient Forms

Eat something within several hours prior to a session. Avoid a hefty meal but a light snack is acceptable.

Avoid caffeine for at least three hours and refrain from alcohol and non-prescribed drugs for at least six hours before a treatment.

It's helpful to keep a journal between sessions to make note of any changes in symptoms or levels of pain.

How Else Should I Prepare?

2 Informed Consent to Oriental Medical Health Care

Provider for United Healthcare and Blue Cross Blue Shield of Texas


Janet Lee Cook

Licensed Acupuncturist and Chinese Herbalist

M.S.O.M., L.Ac., M.S., C.A.S.





New Patients