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New Patient Forms & HIPAA

New Patient Intake Form - To provide you with the best treatment possible, it's important for us to get to know your medical history and health goals.

*Please complete and TEXT to (203)451-9865 IN ADVANCE or bring the completed forms to your first visit. Thank you.*

Notice of Privacy Practices (HIPAA) - This notice is for your records. It describes how your medical information may be used, disclosed during your treatment, and how you can get access to your own records.  

Office Policies

Lateness is 15 mins after the appt time

Your appointment time is reserved exclusively for you, whether you show up or not. It is the patient’s responsibility to show up on time. If you are running behind, pls text or call us. A “late arrival” is 15 mins after the appointment time. We cannot guarantee a shorter treatment if we have a filled schedule that day. The patient may be charged the full hourly rate for a missed appointment. This policy stands for new and existing patients.

Missed Appointment
We Request 48 Hours Notice to Cancel or Reschedule 

We ask for 48 hours notice to reschedule or cancel. It is the Patient’s responsibility to cancel or reschedule appointments. We respect your time at our clinic and reserve it for you. So please respect our time and communicate with us in advance. You can text, email, or call us (203)451-9865 EST. 

We automatically charge $180/hr by credit card on file for a missed appointment, even if you are an “insurance patient with a co-pay” and do not normally pay for treatments out-of-pocket. Thank you.

Katherine Kim
Acupuncture Arts

212 Post Road West
Westport, CT 06880

(203) 451-9865
By appointment