Freeport Acupuncture Center

Mary Beth Hassett, L. Ac., Dipl. O.M.

Acupuncture and Chinese Herbal Medicine

 

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203 Main Street

Freeport, ME 04032

(207) 865-1203

(207) 865 -4422 fax

                  New Patient Forms

Please download and fill out the appropriate forms before your visit.  You can download them in word or in a PDF.

New Patient Letter                  PDF       

Health History Form              PDF         

Women's Form                          PDF

Children's Form                        PDF

Personal Information                PDF         

Consent to Treatment            PDF        

Notice of Practice Privacy     PDF 

 

 

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