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Skip Navigation LinksHome : My Private Practice : New Patients

930 Logan Street #101 & 102
Denver, Co 80203
720.284.1374

Licensed Acupuncturist and Practitioner of Chinese Medicine

John S. Aguilar Jr., L.Ac.

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  Skip Navigation LinksHome : My Private Practice : New Patients

New Patients

Below are the forms and paperwork I use during the initial session. Please feel free to download and review them or even print them out and bring them in completed.


Patient Information Form
Personal information such as name, address, etc., as well as medical information and history.   

PDF    Word Document


Policies Form   
A short review of standard office and practice policies, such as cancellation fees, right to discontinue treatment, and so on. 

PDF    Word Document


Mandatory Disclosure Form   
Information required by Co state law to be disclosed at the initial treatment session, including information on my license, training, professional degree, and board certifications.

PDF    Word Document


HIPPA Notice of Privacy Practices   
This packet describes how medical information about you may be used and disclosed and how you can get access to this information.
 
PDF    Word Document


Acknowledgment of Receipt   
This is a simple form you sign as indication that you recieved a copy of the above 'Notice of Privacy Practices'. 

PDF    Word Document


*You'll need the Adobe Reader to read the PDFs. You can download the latest version here.

All contents Copyright
John Aguilar, Jr. 2008