Forms and Fees

The following information sheets regarding our policies are available for your review and future reference:

Electronic Medical Record Information Sheet

HIPAA – Privacy Notice

Financial Policy for Patients


Please print the following forms, fill them out, and bring them with you for the first visit. If you need help, we can do it with you once you come.

Electronic Medical Records Form

Demographic Form

Pharmacy & Lab Information


Financial Acknowledgement


We apologize for the 5 forms; completing the forms in advance of your appointment will make our experience smoother and you only need to do it once 🙂


If you are coming for Acupuncture , our staff will ask you questions so they can complete Measure Yourself Medical Outcome Profile during each acupuncture visit.

You can find instructions after getting an injection by Dr. Moroz here.

Our current Acupuncture Fees for Dr. Moroz are $130 for a 1-hour session, and $65 for a 1/2-hour ear acupuncture session.