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ACUPUNCTURE / FARM CALL QUESTIONNAIRE, WITH DOCTOR ANDERS NOTES. 

 

CLICK ON THE RED FOLDER TO DOWNLOAD AND PRINT OUR ACUPUNCTURE / FARM CALL QUESTIONNAIRE. 

YOU ONLY HAVE TO FILL OUT THE TOP HALF OF THE FORM, UP TO AND INCLUDING SYMPTOMS,  THE REST OF THIS FORM IS FOR THE DOCTORS' INFORMATION. IF YOU HAVE ANY QUESTIONS WHILE FILLING OUT THIS FORM, PLEASE CALL OUR

OFFICE AT 419-678-3610.   THANK YOU.