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Clinic Intake Forms

New Patients:
Please print your forms in colored ink and fill them out to speed up the intake process during your first visit. 

Community Acupuncture patients only need to complete Informed Consent and Basic Intake. Private Session patients need to complete both of these forms plus the Extended Intake. 

(PDF, Adobe Reader required)

Dr. Larissa Smith, AP, DOM | St. Petersburg
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Dr. Larissa Smith AP, DOM
727-222-6980 Directions Contact/Schedule