AcuHealthcare Patient Registration

To register, please take the time to fill out the information below.

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Energy LevelLowOkayAverageGoodAwesomeEnergy Level
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Stress LevelNot StressedNot very often StressedStressed 3-5 times a weekStressed once a dayVery often StressedStress Level
Muscular Skeletal
Respiratory
Skin & Hair
Neuropsychological
Reproductive
Circulatory
Genitourinary
Gastrointestinal
Senses

I agree to give 24 hours notice if I cannot attend my appointment (to be given to someone in need of urgent treatment). If I do not give notice I agree to pay a fee of €30. If I do not attend my appointment and I have not called, I agree to pay the full consulting fee.

Your Signature