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Note: Since our forms are photocopyable for your personal professional practice, simply customize by adding your label with –name, address, phone, license number, provider number, We no longer do customized work. Look carefully at the Table of Contents of the forms packets. Insurance Superbills are in the Insurance Forms Packet, not in the Big Forms Packet. Since the forms are photocopyable, they are not returnable once opened. We do keep getting ravingly positive feedback over all the years this has been in print..

Packet #1 The Acupuncture & Herbal Medicine Big Forms Packet $65.00 See Discounts for this item. Go to What these forms do for your practice Go to Table of Contents below. Why purchase master forms rather than create them from scratch? When ordering, please specify your profession and if you are in a combined professional practice, ie. chiropractic/ acupuncturist, physician/acupuncturist, acupuncturist/therapeutic massage practice. 160 Mix & Match Forms Includes high quality master forms you may use to photocopy or scan into your private practice computer for your own practice use: Some of these forms are patient empowerment forms which are known to increase the practice with their use 195%! If you buy Acubase, which has a few very basic forms, forms appropriate for the computer can be scanned to add to it. These master forms are designed to be photocopied for your personal practice use. We even make our forms inexpensive enough that your friends can afford to buy them–and you don't have to worry about your forms getting damaged or lost in the process. Discount: $8.50 when purchased with both The Art of Practice Management and Plan together.

TABLE OF CONTENTS FOR THE BIG FORMS PACKET

New Patient Packet • Patient Rights/ Mutual Understanding in the Therapeutic Relationship • Office Procedure & Pt Introduction • Patient Registration & Authorizations • Welcome Brochure – Policies • Payment of Services Information • New Pt. Information on Insurance •Insurance Questions & Answers for Patients • How to Submit Your Insurance Claim • Verification of Insurance Coverage Patient Histories • Patient History Questionnaire–P.1 • Past Medical History • Patient Profile–p. 2 or • Symptom Review–p.2 • Habits and Preferences p.3 • Nutrition, allergies, Medicines–P.4 • Patient History Questionnaire–P. 1 • Current and Former Conditions– P.2 • Nutrition, Habits, Medicines–P. 3 • Females / Males only • Accidental Injury Questionnaire • Workers’ Comp. Questionnaire • Disability Evaluation Questionnaire • Nutrition Questionnaire–3 Pages • Ayurvedic Nutrition Questionnaire Clinic Intake Charts and Reports • Evidence of Continuity of Care Patient Checklist • Consultation Form • Clinical Charts Long & Short Form • 5 Elements Clinic Chart 2 types • Tongue Diagnosis & Findings • Iridology Findings • Patient Progress Notes • Patient Progress Notes – Modified • Acupuncture Treatment Record Card • Patient Progress Report – Pt. Fill in • Treatment Summary Report • Initial Report • Interim and Final Report • Complete Narrative Report – 4 PP. Consent and Authorization Forms • Risks & Benefits of Acupuncture (Including how you correct for those risks!) • Consent for Acupuncture Care • Consent for Investigational Devices • Disclosure of Qualifications/ Records • Disclosure of Supervision • Nutrition/Herbs Consultation/Consent • Pre-authorization Form to Treat • Authorization to Release Medical Information • Physician Referral • Authority to Admit Observers • Consent to Photograph • Authorization for Absence • Disability Certificate • Consent to Treat Minor Child • Authorization to Employer for Workers’ Compensation • Treatment and Arbitration Agreement

Patient Care Forms–Continuity of Care (These can be used individually or in the Pt. Report of Findings Packet ) • Pt. Personal Acupuncture Report p.1 • Schedule of Care, Recommendations p.2 • General Instructions for Care p.3 & 4 • Personalized Instruct. Magnetics p. 1& 2 • Personalized Instructions – P. 3 • Supplement Program – P. 4 • Recommendations • Report of Findings & Health Care Proposal • Patient Wellness Program Contract Referral Building & Patient Follow-Through Material • 7 Appointment and Referral Cards • Thank You for your referral-Letter • Recommendation for pamphlets Appointment Management Forms • Sign-in Register • Professional Appointment Record • Management Control Form #1 • Recall • Reactivation Program Patient / Other Financial Agreements • Payment Plan Schedule • Family Policy • Introducing a Cash Payment System • 60 Days Extension of Credit in Consideration of Assignment • Automobile Accident / Work Injury Policy • Personal Injury Financial Policy • Statement of Report Charges Agreement of Coverage by Patient, Insurance companies, and/ or Attorney • Medical Reports & Acupuncturist’s Lien • Power of Attorney to Endorse Checks to Acupuncturist's Office Business Contracts • Associate Employment Contract • Colleague Agreement • “No Competition Clause” • Independent Contractor Engagement Agreements (3 @ 3-4 pp. • Partnership Agreement for Acupuncturists Hiring Staff Forms • Interview Questionnaire for Hiring Staff • Job Application Form – 2 pages • Inquiry to Past Employers • Wages Sheet Financial Management Forms • Sample Ledger Card • Sample Accounts Receivable Form • Accts. Receivable Aging & Analysis • Expenses Work sheet – 2 pages • Total Monthly Sum. Income #2 • Income Summary #3 • Take Action Letter • Past Due Collection Letter • Year Sum. of Payments & Fee #4 • Profit and Loss Statement #5

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