Winding Path Acupuncture Intake
If you have any questions please contact me at info@windingpathacupuncture.com
Thanks,
Sam Pierceall, L.Ac
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Clinic Policies:

Our office policy requires payment on the day of your visit.

Kindly allow 24-hour minimum notice for change or cancellation of appointment. No shows and late cancellations will be charged a $55 late cancel fee. We absolutely forgive emergencies.

There will be a $30.00 fee for returned checks.

Client services and chart information are confidential. Written authorization is required from you to release any information. Please turn off your mobile phone for optimal relaxation.

Client Agreement: I also understand that at any time I feel pain or discomfort during the session, I will immediately inform my practitioner. I have stated my pertinent medical conditions, and will update the practitioner of any changes in my health status. I understand that my failure to do so may pose a threat to my health and/physical well being and I hold harmless Winding Path Acupuncture and my practitioner from any liability whatsoever arising from failure on my part.

I, the undersigned, have read and understand the above policies:

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Please type your full name below to indicate that you understand and accept this policy.
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