Complimentary Consultation

Let’s Talk First.

This 30-minute consultation is a calm first step to discuss your concerns, answer your questions, and determine whether acupuncture feels like the right fit for you.

Consult Request

Share what you are seeking treatment for, how it is affecting your day-to-day life, and a few consultation times that feel easy for your schedule. These details help Dr. Smith review your request with care and make sure your conversation feels focused from the start.

Your details

Full name

Email address

Phone number

How did you hear about Nu You Acupuncture?

Preferred method of contact

Email Phone Text

Your concern

What are you seeking treatment for?

What symptoms are you experiencing?

How long has this been going on?

Have you tried anything for it already?

How is this affecting your daily life?

Consultation preferences

Have you had acupuncture before?

Yes No Not sure

Preferred consultation dates and times

Choose up to 3 options that work best. Consultations are 30 minutes, Tuesday through Friday between 11:00 AM and 5:00 PM.

First choice

Date

Time

Second choice

Date

Time

Third choice

Date

Time

Do you have any questions about acupuncture or treatment?

Would you like to schedule a first appointment?

Yes Not yet Not sure

Is there anything else you’d like me to know?

Please do not use this form for emergencies or urgent medical concerns. If you need immediate care, call 911 or go to the nearest emergency room.