B O D Y S C A P E S Acupuncture
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Patient Forms 
​Please choose correct form.   


​Online Form
This form can be completed online (approximately 20 minutes) and should be submitted no less than 24 hours prior to your appointment time. These online forms are powered through Jotform. They are secure and HIPAA compliant.

Printed Forms 
If you would prefer to print your form, it must be completed prior to your appointment time. Bring form with you to your appointment. 
If you do not have access to a printer, arrive 20 minutes early to your appointment. Please do not email form. Thank you!

Online Forms - Click button for online form.
Printed Forms - Click "Download File" to print your form.
​
Online New Patient Form - Acupuncture
New Patient Form - Acupuncture
Click "Download File" and print your form.
new_patient_form_2016.pdf
File Size: 241 kb
File Type: pdf
Download File


Online Fertility Patient Form - Women
New Patient Form - Fertility (women)
Complete this form if you are coming in
to be treated specifically for fertility issues.
womens_fertility_patient_form_1.pdf
File Size: 274 kb
File Type: pdf
Download File


Online Fertility Patient Form - Men
New Patient Form - Fertility (men)
Complete this form if you are coming in
to be treated specifically for fertility issues.
mens_fertility_patient_form.pdf
File Size: 357 kb
File Type: pdf
Download File


Online Facial Rejuvenation Form
Patient Form - Facial Rejuvenation
Complete this form if you are coming in to receive Cosmetic Acupuncture (Facial Rejuvenation).
facial_rejuvenation_form_pdf.pdf
File Size: 112 kb
File Type: pdf
Download File


Massage - Online Form
New Patient Form - Massage Therapy
Complete this form if you are only coming in for massage therapy.
1._patient_form_massage.pdf
File Size: 306 kb
File Type: pdf
Download File

Contact/Locations

Phone: 847.864.6464
Fax: 773.672.7084
Email: bodyscape1987@gmail.com


Flossmoor Commons
​Professional Building
3235 Vollmer Rd. Suite 204
​Flossmoor, IL 60422

Schedule Online

Schedule Online
Office Hours
Tuesday - Friday: 10:00am-7:00pm
Saturday: Closed
Sunday & Monday: Classes


Gift Certificates

Purchase Now
Purchase and print your gift certificates all online! Choose from massage, facial rejuvenation, acupuncture, and more.

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