Request your acupuncture records

We're discontinuing acupuncture services. If you'd like your treatment records sent somewhere, fill out this form and we'll take care of it.

Your records stay with us unless you ask us to send them. There's no deadline and no cost to you — this is entirely your choice.

Most people choose to have their records follow them to their new acupuncturist. If you're not continuing acupuncture, you don't need to do anything at all.

About you

So we can find the right chart.

Where should we send them?

Pick one.

Send my acupuncture records to:

What you're authorizing

  • You're asking to release a copy of your acupuncture treatment records — intake forms, treatment notes, and related clinical documentation — to the recipient you chose above.
  • We send a copy and keep the original, which is standard practice.
  • You can cancel this request in writing at any time, up until we've already sent the records.
  • This authorization expires , or sooner if you cancel it.
  • Once your records reach the recipient, they're subject to that recipient's privacy obligations and may no longer be protected by the same laws that cover them here.
  • We won't condition any service on whether you sign this.
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