Jane Gleeson RN MSN L Ac, Licensed and Certified in Acupuncture and Oriental Medicine

Appointment Information

Below are forms to fill out before your first appointment, available in both Microsoft Word and PDF format. Please download, complete, and bring to your first consultation or appointment.


Cancellation and Appointment Policy (Word) download

Cancellation and Appointment Policy (PDF) download


Women's Health Questionnaire (Word) download

Women's Health Questionnaire (PDF) download


Women' Health and Contact Information - Fertility
(Word) download

Women' Health and Contact Information - Fertility
(PDF) download


Men's Health Questionnaire (Word) download

Men's Health Questionnaire (PDF) download


Men's Health and Contact Information (Word) download

Men's Health and Contact Information (PDF) download