Below you will find the new patient forms for our Raleigh acupuncture clinic. In preparation for your first visit please print out the new patient paperwork. If you do not have access to a printer don’t worry you can fill it out when you arrive.

New Patient Packet (pdf)


Additional Forms (only when applicable)

Informed consent to release information (pdf)

HIPPA Privacy Policy (pdf)

Additional Infertility form (pdf)

Physician Referral Form (pdf)


If you arrive more than 15 minutes late for any appointment you will forfeit your appointment. Payment is expected at the time services are rendered unless a signed financial agreement has been prepared in advance. Payment may be made by cash, check, Visa and Mastercard. A $25.00 fee will be charged on all returned checks. We realize that health needs do not always coincide with financial means. When your treatment requires several visits, we will be happy to give you an estimate of the total treatment length and the approximate costs. If you have a special situation or need, please let us know and we will tailor a payment plan designed for your unique circumstances. All herbs, supplements and supplies must be paid for in full at the time they are dispensed. This is over and above any signed financial agreement. Any collection costs, including but not limited to, the reasonable attorney’s fees of Acupuncture Pain and Stress Center, LLC, arising out of, or in connection with collection of past due balances shall be borne by the patient.

At Acupuncture Pain and Stress Center you will get more than a typical acupuncture treatment. Our style of acupuncture enhances the effects of needling by combining it with tuina massage, stretching and orthopedic movements to give you quicker and more effective results.

Our goal since 2010 has been to provide Raleigh, NC and its surrounding areas with the highest quality healthcare and compassionate patient-focused services. In addition to completion of a 4 year graduate program, we maintain a strong commitment to continuing education and ongoing research which ensures that we have the resources to provide you with exceptional, results-oriented acupuncture treatments.



If you keep doing exactly what you’ve been doing is your issue going to stay the same or worsen? Do something different and schedule your first appointment to determine if you are a good candidate for treatment. We pride ourselves on personalized treatments to get you results quickly so you can get back to enjoying life and doing the things you love.

Call (919) 260-4104 now, and I will be happy to answer any of your questions and get you booked for an appointment.