Contact Us
Acupuncture and Lifetime Wellness is located at
 920 North Broad Street Suite 8 in Lansdale
, close to Route 363, 309, 202, 463 and PA Turnpike Northeast Extension 476. It is easily accessed by public transit via the SEPTA Regional Rail R-5 Lansdale/Doylestown at the Lansdale stop, or SEPTA Bus Route 132 at Broad Street and 6th Street in Lansdale.



To schedule an appointment please text:
(267) 644-8013
For more information please call or email:
info@acnlifetimewellness.com

Office hours: by appointment please (times are flexible and subject to availability)
Tuesday: 12:00 p.m. to 5:00 p.m.
Thursday: 8:00 a.m. to 12:00 p.m. and 4:30 p.m. to 7:00 p.m.
Friday: 9:00 a.m. to 6:00 p.m.
Saturday: 9:00 a.m. to 2:00 p.m.






New Patient Form- Print pdf or submit online
!                                  New_Patient_Form.pdf
81.8 KB


Name: *
Address: *
City *
State:
Zip: *
Home or Cell Phone: *
Work Phone: 
Email: *
Occupation: 
Birth date: 
Emergency Contact (name, phone): *
Referred By: 
 Marital Status: 
SingleMarriedDivorced
WidowedSignificant other
Do you have children? 
Yes   No
Have you ever had acupuncture
Yes  No
When: 
Where: 
For what condition: 
Did it help? 
What can acupuncture help you with today?
List all current medications:  *
List all current vitamins, herbs, and other   supplements: *
Significant illnesses:  
Cancer    Diabetes   Hepatitis   Heart Disease
Stroke     Seizures   HIV/AIDs  Pneumonia
TuberculosisThyroidMultiple Sclerosis  Asthma
Stomach Ulcers  STDs  Depression   Shingles
Chronic FatigueRheumatic Fever High Blood Pressure
Other:  
Have you ever had any surgeries? 
(include dates) 
List any allergies: *
 Does your lifestyle include: 
Alcohol TobaccoRecreational drugs
Caffeinated beverages
What do you do for exercise? 
(please include frequency and 
types of activity): 
Please rate your stress level regarding:  
1=no stress, 10= extreme stress
Work: 
Health: 
Love: 

Money: 
Family: 
Future: 
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