Acupuncture Templates

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I put together this post as a reference for which forms you need for which patients, and what they are/how to make them! These forms are essential to your practice: New Patient Information: Pretty self explanatory, this form collects your patient’s basic information (full name, address, email, phone) as well as their insurance information and a thorough health history of current and past symptoms.

Flying Free Don Besig Pdf Editor. I arrange mine by systems (cardiovascular, digestive, etc.) so I can easily scan which systems/TCM organs the patient is having issues with. Informed Consent for Acupuncture: Required by nearly all malpractice carriers, this form lets your patient know the risks and side effects of a typical acupuncture/TCM treatment (bruising, slight bleeding, soreness, etc.), and has a place for them to acknowledge and sign. Notice of Privacy Policies: This form explains to your patient that their health information is confidential except in specific situations, explains that they have a right to their information and how they can obtain it, and has a place for them to acknowledge and sign.

Financial Hardship Agreement for Cash Patients: This is a form that is essentially required by law for all cash-paying patients to sign. It acknowledges that because they are paying cash, your rates are lower than your “full-fee” of what you typically charge insurance companies. It has a place for you to write in you agreed upon “cash” amount, and a place for your patient to sign.

Insurance Authorization and Billing: This is a form that is essential for all patients whom you are billing their insurance. It is essentially just a consent from your patient that you can bill their insurance on their behalf. Minor Release Form: For any patient who is under the age of 18. It is essentially an informed consent for treatment that the patient’s parent must sign. Standard Intake Form: A basic intake form to be used at every treatment.