All VBR and 回診單 can be faxed back to (321) 454-9974 or emailed to .​
​*请email 回診單到 nisacupuncturecenter@gmail.com

To order our HT series of pills, please fill out the following paperwork and email/fax back to us.  

Step 1:

Fill out initial intake

form (2 pages) -------------->

Step 2:

Fill out symptoms

questionaire 3 pages)-------->

Once you click submit on both forms, you will receive an email stating we have received both and will set up a phone consultation if needed.  

 

To do a follow up with your current treatment, please visit 

Online VBR to fill out your current symptoms.

Non-Office/ Out of state visit:

To seek herbal treatment with our physicians, please fill out the following.

Step 1:

Fill out initial intake

form (2 pages) -------------->

Physical 

Forms ------->

Office Visit:

To see one of our physicians in person please fill out the following.