In order to SAVE and return to your form, you will be prompted to create a Jotform account. Otherwise, please just press Submit and your form will be sent directly to HB Acupuncture.
Please provide 24 hours advance notice if you need to cancel your appointment.
If less than 24 hours notice is given the full fee is charged.
No show appointments will be charged the full fee.
Cash or cheque only. Please do check with your insurance company for the cover of acupuncture treatment.
Thank you for completing this form. Your Practitioner will ask you for more details during the consultation.