Admission Forms

For all admissions, you will need to download and fill out the following forms  prior to your first appointment: History   Consent   HIPAA   Fee Schedule    

For TeleHealth, you will need to download and fill out the following form prior to your first appointment:   Consent for TeleHealth    

  • If you are having a face-to-face physical admission appointment with Dr. Ann, you can bring the 4 admission forms with you to your admission appointment.
  • If you are a new patient having a TeleHealth admission, you will need to email or fax the 4 admission forms, the consent for TeleHealth AND the TeleHealth consultation form (see TeleHealth tab) to Dr. Ann PRIOR to your TeleHealth video call.
  • If you are an established face-to-face patient and are using TeleHealth for the first time, you will need to email or fax the consent for TeleHealth AND the TeleHealth consultation form  to Dr. Ann PRIOR to your TeleHealth video call (see TeleHealth or the Forms page for the consultation form).

Wellness Acupuncture

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