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Forms for Counseling or Acupuncture
Call: 828-258-1883
Fax: 206-600-6218
Email: michael@michaelrossoff.com
To discuss • Scheduling an appointment • Cost for the consultation • Location for the appointment
Fax: 206-600-6218
Email: michael@michaelrossoff.com
To discuss • Scheduling an appointment • Cost for the consultation • Location for the appointment
For Personal Counseling
What to Bring to the Consultation
• Filled-out the Personal History Form (below) • Read Important Pre-Consultation Info (below) • Bring Medical Reports (only most important) • Write Questions (on a separate paper) that you want to be sure get answered |
For Acupuncture Treatments
What to Bring to the Initial Evaluation
• Filled-out Personal History Form Only (below) • See the bottom of the Acupuncture Practice page for certain important do’s and don’ts • Your first treatment immediately follows the initial evaluation |
Personal History Form
These forms must be filled out in advance. Please download the appropriate form with the links below. Then open it on your computer, print it out, and then fill it out (in black ink).
Please be aware that the use of these forms are specific to my healing work. Other counselors or acupuncturists will use their own form. Please do not need to mail or send it on to me in advance of our appointment unless we are doing a telephone or Skype session. I prefer that you bring it with you to the initial meeting. I look forward to meeting you! Personal History Form
(3 pages, in pdf format) |
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Directions to Appointments in Asheville, NC |
Directions to Appointments in Rockville, Md. |
Important Policy for Deposits & Cancellation in Bethesda, Md.
For All Clients--New, Revisit or Acupuncture-- seeing Michael Rossoff in Maryland Please read this important document. Deposit for Consultation in Rockville, Md. — April, 2020This deposit is for $100 toward the full fee for a consultation. It is non-refundable if you cancel with less than 8 days notice, unless the appointment is rescheduled during the same trip. The deposit is through PayPal, which you do not have to join in order to use. |
Deposit for Acupuncture in Rockville, Md. — April, 2020This deposit is for $ 75 toward the full fee for an initial acupuncture treatment which includes an evaluation. It is non-refundable if you cancel with less than 8 days notice, unless the appointment is rescheduled during the same trip. The deposit is through PayPal, which you do not have to join in order to use. |