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S.P.A.S.M. ACUPUNCTURE
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Office Forms


All online forms are HIPAA compliant and fully encrypted for your peace of mind and protection. 

New Patient Forms
COVID-19 Patient Advisory and Acknowledgement
credit card authorization form
*Credit Card Authorization form is only if you would like the office to keep your card on file. Your full card number is not required on this form. It will be put on file only when you are making a transaction with me at the office. Square requires written authorization in order to keep cards on file. Please contact the acupuncture clinic if you have further questions. 
Serving Silicon Valley & San Mateo Counties including the following cities of
Campbell, Cupertino, Monte Sereno, Los Gatos, Saratoga, West San Jose, Atherton, Los Altos, Menlo Park, Portola Valley, Redwood City, San Carlos, Stanford, Woodside

 Copyright 2011 SouthBay Pain & Sports Medicine Acupuncture. All rights reserved. San Carlos & Los Gatos (California) offices
​www.spasmacupuncture.com•miki@spasmacupuncture.com•(408) 600-1513​
  • Home
  • COVID-19
  • About Me
  • Insurance & Fees
  • Office Forms
  • Logo Designs
  • Blog
  • Contact