Affordable. Safe. Effective.  
728 South Avenue Rochester NY 14620 | 585.287.5183   

NEW PATIENT PAPERWORK

Please print, complete, and bring to your first visit! This helps keep our costs down, and makes your first visit easier!

WELCOME LETTER
Explains what to expect at your first visit, and how RCAc works.

HEALTH HISTORY FORM
Gives us valuable information about your medical history, and what you are coming to acupuncture to treat.

SLIDING SCALE INFORMATION
Explains how we make acupuncture affordable for everyone.

FINANCIAL AGREEMENT
Explains our cancelation policy and helps us keep our costs lower.