In order to allow maximum treatment time during your initial session please print and complete these five forms. Bring the completed forms to your first visit or scan and email them to janetcookwellness@gmail.com

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

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?

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

2 Informed Consent to Oriental Medical Health Care

Provider for United Healthcare and Blue Cross Blue Shield of Texas

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Janet Lee Cook

Licensed Acupuncturist and Chinese Herbalist

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

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Janet

Oncology

New Patients

512-826-1164             janetcookwellness@gmail.com