Patient Information

Do you like to be prepared?
View, print, or download our patient information forms. Complete them in your spare time. Bring them in with you at your next appointment.

New Patient Information Forms

Download All Files Zip File - 13.8 MB
Welcome
Patient Request for Records
Dietary Needs Questionnaire
Medical History
Symptom Survey
Medical Policy
Privacy Policy
Yeast Questionnaire

For More Information, 870-772-8622

Content Copyright 2003 - 2005 - Northfield Acupuncture and Alternative Medicine Clinic
Northfield Acupuncture & Alternative Medicine Clinic, Inc., Dan Martin, O.M.D., D.O.M.

Contact Email: northfieldclinic@txk.net
619 East 6th Street - Texarkana, AR - (870) 772-8622

DISCLAIMER:
The statements and opinions expressed by Dr. Dan Martin/ Northfield Acupuncture and Alternative Medicine Clinic in written, audio, video or other formats have not been evaluated by the Food and Drug Administration (FDA). Information and or treatments received from Dr. Dan Martin / Northfield Acupuncture and Alternative Medicine Clinic are not approved by the Food and Drug Administration (FDA) to diagnose, treat, cure or prevent any disease.