Patient’s Rights
The patient is entitled to receive information about the methods of therapy, the techniques used, and the duration of therapy if known [see Consent Form].

The patient is entitled to seek a second opinion from another health care professional and may terminate treatment at any time.

The patient should be aware that in a professional relationship, sexual intimacy is never appropriate and should be reported to the Director of the Division of Registrations in the Department of Regulatory Agencies.

This clinic is in full compliance with all rules and regulations promulgated by the Colorado Dept. of Health, including the sanitation of acupuncture offices. For the safety of all patients, only pre-sterilized, disposable needles are used.

The practice of acupuncture in the state of Colorado is regulated by: Colorado Dept. of Regulatory Agencies

1560 Broadway, Suite 1340
Denver, CO 80202
(303) 894-2464
Sign in to Google to save your progress. Learn more
Patient's name: *
Writing your name acts as your signature
I agree with the statements above *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Peak Performance Acupuncture.