Be Well Family Acupuncture
9086 Cypress Green Drive, Suite C
Jacksonville, FL 32256
(904) 990-3228
(904) 295-0127 Fax
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Schedule Appointment

New Patient Paperwork

If you don't have access to a printer so that you can complete the form prior to your appointment, please come to your scheduled appointment at least 15 minutes early in order to fill out the necessary paperwork.
  • ALL NEW PATIENTS - Please fill out New Patient Intake and Consent Forms
acu_paperwork_jca_2015.pdf
File Size: 212 kb
File Type: pdf
Download File

  • FERTILITY PATIENTS--Please Fill Out These Additional Forms. 
Female Fertility Intake
File Size: 84 kb
File Type: female fertility intake form
Download File

infertility_cure_questions.pdf
File Size: 72 kb
File Type: pdf
Download File

  • FUNCTIONAL MEDICINE & CLINICAL NUTRITION PATIENTS--Please Fill Out These Additional Forms.
metabolic_assessment_form.pdf
File Size: 116 kb
File Type: pdf
Download File