PATIENT FORMS
To streamline your visit, we've made all necessary patient forms available online for your convenience. Simply download, complete, and bring them to your appointment so we can focus on providing you with the best care possible.
Bonsai Patient Info (Fillable PDF):
Bonsai Financial Agreement (Fillable PDF):
Please review the Notice of Privacy Practices; printing is not necessary. You only need to sign the Acknowledgement of Privacy Practices form below.
Acknowledgment Notice of Privacy Practices (Fillable PDF):
Acupuncture Informed Consent to Treat (Fillable PDF)
Authorization for Release of Information (Fillable PDF)
Arbitration Agreement (Fillable PDF)
Request for Medical Records (Fillable PDF)
Note: Patients are required to complete this form only if specifically requested.
“It is my great pleasure and a honor to write this review!
I have known Dr. Kerri Fitzgerald since 2016 when we both started learning acupuncture at Helms Medical Institute and have been receiving treatments from her to carry me through ever changing landscape of life; to help me cope with pregnancy, challenges of motherhood and professional challenges as well... There also were injuries, some personal losses, respiratory infections, you name it , ‘just normal stuff’ ;) It is always comforting to know that Kerri is there ready to put the needles where they are the most needed and I have never been disappointed! Great care, every time.”