Please fill out these forms in advance or arrive at least 15 minutes prior to your first appointment to fill them out:

Prism Integrative Acupuncture Intake Form


Payment Policy:

In respect for our intentions to offer high quality healthcare at affordable prices, we ask for 24 hours advance notice to cancel or reschedule an appointment. Per our payment policy, all appointments that are cancelled with less than 24 hour notice, as well as missed appointments, will be charged the full amount of the visit. This amount will be charged to your credit card on file, or billed to you to be paid prior to your next appointment. Exceptions are given for emergencies. Please let us know if this was an emergency and we will override your bill.

Fragrance Policy:

The clinic is fragrance-sensitive, but uses moxibustion (burning mugwort) and practitioners may use essential oils in the nearby treatment rooms. Please be respectful to others who may be sensitive to fragrances, including pregnant people, people with migraines, asthma, allergies, COPD, or MCS, by not wearing perfumes or scented products for your treatment.

Non-Discrimination Policy:

We are body/size-positive, LGBTQI-2s inclusive, poly and kink-aware, and sex worker friendly. We do not discriminate with regard to age, race, class, ability, sexual orientation, gender, or gender expression, etc.

HIPAA Policy:

We follow the confidentiality guidelines set by HIPAA. Click here to view our full HIPAA policy. The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically.  The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The Rule also gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections. For the current full legal text, visit

Notice to Consumers:

Acupuncturists are licensed and regulated by the California Acupuncture Board (916) 515-5200