Patient Intake Forms

General Medical History Form  * To be filled out by all Acupuncture Clients over 18

Female Menstrual/Fertility Intake Form    * Please fill out General Medical History Form as well

Male Fertility Intake Form  * Please fill out General Medical History Form as well

Pediatric Intake Form (18 and under)

Massage/Reiki Intake Form 

Mayan Abdominal Therapy Intake Form


Patient Handouts

Thanks to Debra Betts author of "The Essential Guide to Acupuncture in Pregnancy and Childbirth" for handouts below.

Menstrual/Fertility Charting

Fertility Preparation

Male Fertility

Nausea and Vomiting During Pregnancy

Postnatal Recovery and Diet

Other Resources/Places/Practitioners We Love

American Board of Oriental Reproductive Medicine (ABORM)

Resolve- The National Infertility Association

Fertility Friend
Online ovulation calendar and fertility calendar

Circle + Bloom MInd Body Programs for Fertility, Pregnancy, and Women's Health

Resolve Peer-Led Fertility Support Group

Quest Fertility Support Group

Well-Rounded Maternity Center 
Local birth center offers classes, workshops, support groups, and boutique

Placenta Encapsulation- Jillian Beglan
Our acupuncturist Jillian is also a certified placenta encapsulation specialist. Benefits include improved milk supply, prevention on baby blues, reduction of postpartum bleeding, reduction of pain post-birth, and replenishment of essential hormones and nutrients to nourish mom after birth.

CARE Network of Wisconsin
Organization of local practitioners that work with women during childbearing years

Holistic Mom's Network

Postpartum Progress
Resource for those suffering with postpartum depression

The Essential Connection (Heidi Jost)
Mayan Abdominal Massage Therapy

Keenan Wellness (Denise Keenan)
Hypnotherapy, HypnoBirthing®, Breathwork, and Lomi Lomi Massage

Wild Workouts & Wellness
Personal Training and Exercise Programs