elements holistic wellness
Acupuncture, Chinese Herbal Medicine, Chiropractic & Therapeutic Massage
New Patient Forms at Elements Holistic Wellness
Please call or e-mail to make an appointment before filling out intake forms.

New Patient Intake - Acupuncture and Chiropractic
Motor Vehicle Accident Information

If you have been in an auto accident and wish to have your auto insurance billed, please fill this form out in addition to the acupuncture/chiropractic form or massage form. Thank you!
Please come 20 minutes early to your first appointment with us if you have not filled out your paperwork ahead of time.

Not sure if you have alternative care insurance coverage? Call us and we will check for you!
(503) 656-5510
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