FORMS TO DOWNLOAD

Please fill out the forms below as completely as possible and bring them with you to your first appointment
New Patient Intake Form 

Privacy Policy
Confidentiality and Payment Agreement
Consent and Release Form



DOWNLOADABLE INSTRUCTIONS and INFORMATION

5 Minute Acupressure Facelift
How to Prepare a Raw Herbal Decoction
Quitting Smoking with TCM
Vegetarianism and Chinese Medicine Diet Therapy


NEW PATIENTS

Please arrive to your appointment 15 minutes early to fill out new patient paperwork if unable to download/print the above link. Payment is due at time of treatment. If applicable, please bring records of any medications and/or supplements you take; and please make sure you've eaten before receiving your treatment.

INSURANCE 

In network with:
Blue Shield of California PPO
United Healthcare
​Optum Health
Premara Blue Cross
California Schools VEBA
Easy Choice Health Plan
Sutter Health Plus
Spring Hill School-The Advanced Elementary School

Out-of-network provider for all PPO insurances.

Please bring insurance card at time of first appointment to ensure a speedy verification process, or fill out the fields at the bottom of the page.

ACCEPTED FORMS OF PAYMENT

Cash
Check
Visa
Mastercard​
American Express
Discover
Flexible Spending Account (FSA)
​Health Savings Account (HSA)​



CANCELLATION POLICY

Dahms Acupuncture requires 24-hour cancellation notice for all set appointments. Please expect a 50% charge of the scheduled treatment when given less than 24-hour notice. This policy is in place out of respect for the practitioner and patients. Cancellations with less than 24 hours notice are difficult to fill. By giving last minute notice or no notice at all, you prevent another patient from being able to schedule into that time slot. Please keep in mind that late arrivals may result in a shorter treatment.

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