Spokane Acupuncture Fertility Dr Coleen Smith
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Home » Forms
Forms

Forms



Required

Consent to Treatment

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Patient Insurance Information

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HIPPA Notice of Privacy Procedures

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Other

Health History

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Medical History

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Men’s Fertile History

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Women’s Fertile History

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Notice of Privacy Practices

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Patient Information

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Women’s Basal Body Temperature Worksheet

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Dedicated to providing natural, quality healthcare.

Our Contact Info

12211 E. Broadway
Spokane Valley, WA 99206
Ph: (509) 928-2777
Fax: (509) 928-2778

info@spokaneacupuncture.com

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Directions
  • Westbound on I-90
  • Take Exit 289 onto Pines Road
  • Turn Right onto Broadway Ave.
  • Turn Right into the first driveway
  • We are between a Hair Salon & a Hearing Clinic