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Patient Forms

Please print and fill out the appropriate Registration and Health Questionnaire forms.  Please 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
960 E. Green Street, Suite L-10
Pasadena, CA 91106
Tel : 626-793-8988
Fax: 626-793-8088