Holistic Wellness HOLISTIC WELLNESS First Name: Last Name: Our goal at Meridian Acupuncture & Wellness is to support and offer a holistic approach to wellness. We believe that rebalancing the body for optimal health requires pinpointing and adjusting the physical, mental, spiritual, and environmental imbalances in our lives.Meridian Acupuncture & Wellness offers the services listed below. Every individual is unique in what they need to reach optimal health, and you may benefit from any combination of our alternative care options. If you feel that you could benefit from our other services, please complete this form.I am interested in the following services, and I would like a practitioner to contact me to discuss what a treatment plan would entail. Acupuncture Naturopathic Healthcare Hypnotherapy Counseling Massage Therapy/Breema Bodywork Designed Clinical Nutrition Are you interested in our weekly informational emails (healthcare videos and acupuncture information)? Yes No Would you like us to find you on Google+? Yes No I understand that by signing below I’m releasing my contact information to the practitioners of the alternative care options marked above. Patient's Name: Phone Number: Date: Your submission is being processed. You can print out your form by following this unique link. Do not share it with anyone. https://meridianacupuncture.com/resources/forms/patient-form/print-form/?auth={{code}} Thanks for your submission. Please print this form out or save as PDF and bring it with you to your appointment in case the submission failed.Secure HIPAA compliant forms by FireSpike LLC 1-800-996-9689