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PATIENT FORMS

Please bring your completed New Patient Questionnaire on your first visit to Eugene Family Acupuncture. The following forms are formatted for Adobe Reader (PDF). Simply download the file, print out the form, and fill it out to the best of your ability.

New Patient Questionnaire

Eugene Family Acupuncture logo

P.O. Box 146, Lowell OR 97452

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Tel: 1-541-525-9580

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© 2025 by Eugene Family Acupuncture.

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Privacy Policy

At Eugene Family Acupuncture, we respect your privacy and are committed to protecting it.

Information We Collect
Our website does not collect, store, or process personal information from visitors.

How Information Is Used
Since no personal information is collected, no personal data is used or stored.

Sharing of Information
We do not share personal information with third parties.

SMS Communications
If you choose to communicate with us via SMS, your phone number and consent are used solely for business communication purposes.
SMS consent is not shared with third parties for marketing purposes.

Contact Information
If you have any questions regarding this privacy policy, please contact us at:
541-525-9580

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