Directions for Completing and Emailing the E-fillable Health History Form
Complete the e-fillable Health History form. When completing the medications section, be sure to include all pharmaceutical medications, over-the-counter meds., herbs, vitamins, and supplements. Save your form as a pdf file* with your last name and the date as the title. Check the newly saved form for completeness. Email your newly named file as an attachment to our secure email address, firstname.lastname@example.org. It is wise to print a version our your completed form and bring with you to your first appointment. We recommend emailing your form 1-2 days prior to your visit so we can make better use of your first appointment. Thanks.
* To save form as a pdf file, choose "Print" and under "Destination" choose "Save as PDF" instead of your local printer. This will save your completed form as a pdf file that you can then attach to your return email.
If you have trouble completing or saving the form, switch your browser. Internet Explorer usually works well.
Note - We request 24 hours advance notice for rescheduling or canceling appointments. Late notification prevents others from getting care as soon as they wish. A fee of $50 is charged if less than 24 hours notice is given. Insurers do not reimburse for missed or cancelled appointments.
Find us adjacent to Keene Medical, next to Noyle Johnson Insurance, and across from VT Tire and Slope Style Ski & Ride. Bliss Healing Acupuncture has ample free parking. We are pleased to be wheelchair accessible.