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New Patient Forms

Please print these forms, fill them out and bring them in to your first patient appointment. If you cannot fill these forms out prior to your appointment, please arrive 15 minutes before your scheduled appointment time to complete them in our office.

Health History QuestionnaireClick here to download (.pdf)

Medications and Supplements - Click here to download (.pdf)

New Patient Forms - Prairie Spring Acupuncture Clinic in Palatine, IL

Prairie Spring Acupuncture Clinic
Kathi L. Wotal, L.Ac.,
MSOM, Dipl. OM
600 N. North Court, Suite 230
Palatine, Illinois 60067
Phone: (847) 221-8644

By Appointment Only
Tuesday 12-7
Thursday 10-5
Saturday 9-12

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