Patient Forms

Please download and fill out the appropriate forms and bring them with you on your first visit.

For insurance and cash patients:
Registration Form
Health Questionnaire

For workers' compensation patients:
Registration Form
Health Questionnaire


Jean S. Tom Acupuncture
127 N. Madison Avenue, Suite 219
Pasadena, CA 91101
Tel : 626-793-8988
Fax: 626-793-8088