Island Acupuncture & Massage

Before your first visit, we ask that you fill out our intake form. Please print the appropriate form below, fill it out and bring it with you to your first visit. If you have any questions, contact us at or 252-449-8122.

Acupuncture Intake Form (Pain only) (pdf format)

Acupuncture Intake Form (Complex) (pdf format)

Massage Intake Form (pdf format)


The following document may also help you speak with your insurance company in a way that might lead to coverage. This is for your reference only.

Insurance Information & Checklist (pdf format)