3456 Holiday Court
Bettendorf, IA 52722
Ph: 563-332-7110
Fax: 563-332-7234
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Submit forms online

New Patient: Massage Intake Form*

Systems Survey

New Patient: Acupuncture Intake Form*

*All forms are in Adobe PDF format. Click here to download the free Adobe Reader.
NOTE: New patient forms cannot be submitted on a smartphone but can be done on a computer or tablet.