New Patient Forms & Policies

New Patient Information

Below you will find our New Patient Health History form, HIPPA policies, and Informed Consent.  Please take the time to carefully complete it and bring it with you to your first appointment.  

If you are not able to complete if before your visit, please arrive 15 minutes prior to your scheduled appointment time.  *Please let the office know if you will need to come in ahead of schedule to fill out paperwork.  Due to COVID-19, we have increased time between patient visits.    

Office phone: 215-680-2362

Email: mfatimah@me.com

New to Acupuncture?
These recommendations will help you maximize the benefit of your sessions


  • Eat a small nourishing meal before your appointment (two hours prior to your scheduled time is ideal).
  • Allow time for rest relaxation post-treatment whenever possible.
  • Drink water. Your body will be more receptive if you are well hydrated.
  • When the weather is cool, or if it’s a windy day, make sure that you wear a scarf and protect your neck.


  • Caffeine (before and after treatment)
  • Strenuous physical activity (avoid after treatment)
  • Cold and raw foods (raw salads, iced drinks).
  • Wearing make-up, perfume, and scented moisturizers

Fertility patients:

Please keep your feet, neck, lower back and sacrum warm and protected.  Allow time for proper nutrition and rest.  Avoid walking barefoot on cold floors and avoid overly spicy foods.
These recommendations are rooted in the principles of Chinese Medicine – some of them may sound odd without an understanding of their basis, but are important information for most fertility patients.

Clinic Policies
Payment is due at the time of service.
All credit cards, check, and cash are accepted forms of payment.  Contactless payment is preferred and is available using Venmo or PayPal.

Insurance Information

For patients who are out-of-network, we can provide you with a super bill  to submit to your insurance carrier. Before coming in, call the phone number on the back of your insurance card to find out whether your insurance covers acupuncture, and if you can work with an out-of-network provider.  You may also want to find out what conditions are covered in your plan.  Many plans cover back pain, neck pain, and nausea related to chemotherapy. 

Cancellation & Late Arrival Policies
We have a firm 48 hour cancellation policy.  If you do not cancel your appointment within 48 hours of your scheduled time, you are responsible for the cost of the session.  Arriving more than 30 minutes past your scheduled appointment time will not allow sufficient time for treatment and results in a missed appointment fee.

In the event of an emergency or inclement weather, the late cancellation fee does not apply.  On snow days, you can stay in touch with the Clinic as the day progresses to make an informed decision as to whether it is safe enough to travel.  Text or call the office phone at: 215-680-2362.