Katherine Herbert, Dipl.OM, L.Ac.,RN, LMT - Acupuncture, Nutrition & Lifestyle Medicine

Welcome!  This is your new patient information packet.  Please take time to read, fill out, and sign the appropriate sections.  Please plan to arrive 15 minutesprior to your scheduled appointment time as this allows me to better take care of your needs.  If you wish to cancel or reschedule your appointment, please contact the office 24 hours or more in advance.  There is a $75 administrative fee for missed appointments or for appointments not cancelled 24 hours in advance.It is my goalto provide each patient the best care possible.  If you feel you have been treated otherwise, please let me know.

Patient Signature__________________________Date____________

Last Name_________________________FIrst Name_____________

Date of Birth__________Age____Height_________Weight________

Address_______________________Social Security #_____________

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