Contact Us

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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