Acupuncture Clinic XYZ 338, Carson City, Nevada
Consent Form Informed consent form for___________________________. [Name of Principle Investigator]. Personal Information of the Patient Address: _________________________. Telephone no: __________________________. Any previous illness or medical conditions Detail: _________________. Name of the previous physician, if any________________________________. Insurance no. __________________________________. At our Acupuncture Clinic 338, Carson City, Nevada, we provide quality acupuncture therapy in compliance with state laws and regulations. The first-time examination fee will be $145 and further will be charged