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New Patient Intake Forms

*Please Read Our 2020 COVID19 Procedures, Policies & Safety Instructions

Please call our office if you have any questions or need help accessing the Patient Registration and Intake forms. If possible, we prefer that you print the forms and fill them out at home prior to your appointment so that you can take your time.

We have two categories of forms, Adult and Child.

New Patient Registration & Intake Forms For An Adult – Age 18 And Above

Peter Hanfileti, MD and Lisa Hanfileti, LAc (Licensed Acupuncturist) treat adults of all ages. They both perform acupuncture but were trained differently. Peter is Board Certified in Medical Acupuncture and is also certified in a gentle non-needle tapping methods he uses with kids. All children and any adults that are afraid of needles or have a complex history and are on multiple medications, are recommended to schedule with “Dr. Pete”.

Lisa Hanfileti, LAc is a licensed acupuncturist trained in Traditional Chinese Medicine and her strengths are in treating pain conditions, including arthritis, headaches, post-surgical pains as well as fertility issues, insomnia and mental/emotional imbalances that contribute to a general malaise.  She has additional training in herbal and nutritional support and is certified in Diet & Lifestyle Intervention.

It’s up to you to choose whether you schedule with Peter or Lisa. We even have a few patients who alternate seeing us both! Once you are an established patient you are welcome to switch between Peter & Lisa, with the exception being all children are seen by Dr. Pete. 

Please click to open all 5 document links below. They should open in your PDF reader so that you can print each one out. (If you need a PDF reader you can download Adobe Reader for free here: Get Adobe PDF Reader.

  1. Adult New Patient Welcome Letter – Read only. This explains what to expect at your first visit.

  2. Adult New Patient Registration & Intake Form – Print, fill out, bring with you

  3. Adult Informed Consent – Print, sign, bring with you

  4. Adult Financial Policies – Print, initial, sign, bring with you

  5. Points of Origin’s COVID19 Procedures & Safety Instructions* – Please READ and follow instructions

*NOTE: All patients must wear a face mask the entire time you are in the clinic, including during the treatment time. Please bring your own mask. Cloth coverings are fine. 

New Patient Registration & Intake Forms For A Child– Age 17 And Younger

Peter Hanfileti, MD or “Dr. Pete” as his patients call him, is Board Certified in Pediatrics and sees adults as well as children. He specializes in helping children with anxiety and has created an online course for parents. Because of his expertise with kids and years of experience applying natural medicine therapies, he is often able to address conditions that western medicine has no satisfactory answer for.

He does NOT use acupuncture needles on kids but instead uses the principles of the traditional Chinese medicine system to determine treatment strategies. He uses techniques that most kids tolerate very well (and even look forward to receiving). These may include such things as gentle tapping, acupressure at specific points, application of therapeutic grade essential oils, colored light, herbal remedies and nutritional advice.

Please click to open all 5 document links below. They should open in your PDF reader so that you can print each one out. (If you need a PDF reader you can download Adobe Reader for free here: Get Adobe PDF Reader.

  1. Child New Patient Welcome Letter For Parents – Read only. This explains what to expect at your first visit and how “Dr. Pete” approaches the health and well-being of your child.

  2. Child New Patient Registration & Intake Form – Print, fill out, bring with you

  3. Child Informed Consent – Print, sign, bring with you

  4. Child Financial Policies – Print, initial, sign, bring with you

  5. Points of Origin’s COVID19 Procedures & Safety Instructions* – Please READ and follow instructions

*NOTE: All pediatric patients and parents must wear a face mask the entire time they are in the clinic, including during the treatment time. Please bring your own masks. Cloth coverings are fine.