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online forms

All Patients

Please print & fill out the General Intake Form.  Email (info@skylinewellnesscenter.com) or fax (703.879.5860) to our office, including a copy of your driver's license and insurance card within 24 hours of setting your appointment.  It will allow us time to verify insurance before you come for your visit.  If you do not have access to a printer or fax, you can bring the form filled out to your appointment.  If you cannot fill out the forms prior to your visits, please come 15 minutes early so you can work on them.  The General Intake Form makes reference in the signature page to most forms below.  

General Intake Form

HIPAA Notice of Privacy Practices (review; no need to print)

Financial Policy | Cancellation & Rescheduling Policy (review; no need to print)

Employment Injury Intake Form (if applicable, please print and send with General Intake Form)

ChiroHealth USA (if desired, please print and send with General Intake Form)


Forms to Review & Sign:

Chiropractic Informed Consent to Treat


Before you come for your acupuncture visit: 

  • Bring a list of all medications and supplements you are taking. 
  • Please do not wear any perfume or scented lotions for our environmentally sensitive patients. 
  • If possible, wear loose clothing that you could roll up sleeves or pant legs for accessibility. Otherwise, we may ask the patient to wear a robe if the area to be treated is difficult to access.
  • Have a light meal or snack before the visit. Acupuncture on an empty stomach could cause light headedness. Heavy meals or large amounts of caffeine just before a treatment are not optimal either, and especially no recreational drugs or alcohol.
  • Drink enough water on the day of the treatment. 
  • Do not eat or drink food that changes the color of your tongue (as we will be looking at your tongue as a diagnostic method).

If possible, after your acupuncture visit: 

  • Do not drink alcohol. 
  • Do not eat greasy or spicy foods.
  • Rest is preferable so make the rest of the day as easy as possible. 
  • Do not do any strenuous exercise. 
  • Do not shower.

Forms to Review & Sign:

Acupuncture Consent to Treat & Arbitration Agreement


Forms to Review & Sign:

Massage Therapy Informed Consent to Treat