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Have you ever had acupuncture before?

What type of substance use brought you here? (example, Alcohol, Meth, Pain meds, etc)

Approximate length of time you have struggled with substance abuse?

Any current/ongoing health issues or accidents that Dr. April should be aware of before she treats you?

An example of this is if you have a medical condition like high blood pressure, heart issues, strokes, have had a head trauma or consequences of a physical accident that continues to affect your body & life.

What medications are you currently taking or have been prescribed

Is there anything else about yourself and your health that you would like for Dr. Johnston to know about?

Women only: Is there a chance you could be pregnant?

PLEASE READ THE INFORMED CONSENT, HIPAA, AND ARBITRATION LINKS ABOVE BEFORE SIGNING YOUR NAME BELOW.

By typing in your name below, you are agreeing to treatment by Dr. April Johnston and her clinical policies outlined in the links provided above. You also understand and agree that because you are in a treatment facility, Dr April Johnston may discuss your case and treatment outcomes with your professional treatment staff. PLEASE TYPE YOUR NAME BELOW TO AGREE TO ABOVE TERMS AND BE TREATED BY DR. APRIL JOHNSTON, DACM, DAc., Dipl.OM