Acupuncture Intake Form

If this is your first time booking in with us or haven't been to the clinic in over a year, please fill out the information below

Have you tried acupuncture before?
Select an option for your Gender
Do any of the following help you with pain?
Select from the following to describe your bowel movements
Do any of the following make your pain worse
How are you sleeping at night?


We acknowledge that we are on Traditional Lands, referred to as Treaty 6 Territory and that the City of Saskatoon and all the people here are beneficiaries of this peace and friendship treaty. Treaty 6 encompasses the traditional territories of numerous First Nations, including Cree, Dene, Nakota, Saulteaux & Ojibwe. It is the homeland of the Metis Nation. We are dedicated to ensuring that the spirit of Reconciliation and Treaty 6 is honoured and respected.