Patient Forms

Please print the following forms, answer the appropriate questions and bring the forms to your initial visit:

Health History Questionnaire

Informed Consent

Please either bring documentation that you have been to a doctor or chiropractor for your condition or sign the following form:

VA Recommendation

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Harmony Acupuncture and Healing Practices
Christie M. Savage, L.Ac., Dipl.Ac. (NCCAOM)
3052 Berkmar Dr Suite B
Charlottesville, VA 22901
Charlottesville:434-242-8305
Staunton:540-245-0235


Harmony Acupuncture and Healing Practices
Christie M. Savage, L.Ac., Dipl.Ac. (NCCAOM)
11 E. Beverly St. Third Floor, Suite 17
Staunton, VA 24401
Charlottesville:434-242-8305
Staunton:540-245-0235