New Patient Inquiry

I am glad that you are interested in working together! ✿

Please fill out the following form if you would like to request an initial consultation and acupuncture appointment. If you have any questions or concerns you would like to address before booking, please add them at the end of the form.

Name

First Name

Last Name

Preferred pronouns:

She/her

They/them

He/his

Phone

(###)

###

####

Availability

What is your availability for a 1.5 hour initial consultation and treatment? Appointments are available Tuesday through Friday. Please specify what times of day work for you. Please bear in mind that, depending on my current patient load, it may take weeks before I am able to accommodate you.

Any questions or concerns prior to booking? Anything more you would like me to know?

Please keep in mind that these forms are not a secure means of communication. If you would prefer to phone, please feel welcome to call the number at the bottom of the page.

How did you hear about my practice?

Are you 18 years old or over?

Yes

Moonspring

145 Waterman Street
Providence, RI, 02906
United States