Patient Forms

Please print the following forms, answer the appropriate questions and bring the forms to your initial visit:

Health History Questionnaire

Informed Consent    Print and fill in                  

Informed Consent Complete Online


Please either bring documentation that you have been to a doctor or chiropractor for your condition or sign the following form:

VA Recommendation


Harmony Acupuncture and Healing Practices
Christie M. Savage, M.A., Dipl.Ac. (NCCAOM)® . L.Ac.

1415 Sachem Place Suite 2-B
Charlottesille, VA 22901

2303 N. Augusta St
Staunton, VA 24401