General Intake Forms

Please fill out each of these forms prior to your appointment at Blossom Clinic. You can scan them back to us or bring them in with you.

Consent To Treat Blossom Acupuncture

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Health History Forms

Please choose one of these forms and fill it out prior to your appointment at Blossom Clinic. You can scan them back to us or bring them with you. We look forward to meeting you!

Female Fertility

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Male Fertility

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General Health History For health concerns other than fertility or pregnancy

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Other Forms

Please use this form if you would like to check your “out of network“ acupuncture benefits. We are a fee-for-service clinic and if you have out of network coverage, we will provide a super bill for each session that you can submit to your insurance company. Email us if you have any questions! We’re here to help.

Insurance Verification

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