Forms

Acupuncture Durango,COPrior to your first visit, please print out this following forms and fill them out accordingly. This will allow more time for us to address your concerns and discuss a treatment plan.


RIKKI GENSHEER, LAC
ACUPUNCTURE AND ASIAN MEDICINE
Durango,Co PuraVida Healthcare Coop

FEES FORMS
  • Intake Consultation and Treatment, 2 hours $120
  • Follow-up Treatment Established Patient, 1 hour $75
  • Follow-up Treatment Established Patient, Needle Visit Only ½ hour $40
  • Follow-up Treatment Established Patient Age 15 and under, 1 hour $50
  • Herbal Consult Only $30
  • Cost of Herbs $20-$30
Confidential Health Questionnaire
Notice of Privacy Practices
Acknowledgement of Receipt of Privacy Practices
Patient Consent Form
Informed Consent  for Acupuncture Treatment and Care
Disclosure Statement

 

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Acupuncture Durango, Co located at Pura Vida Healthcare Coop. 160 E. 12th St., Ste 1 Durango, CO 81301 Call: 970-426-1684