Priority Provider Contact

Your Name:
 Your E-Mail Address:

Do you have acupuncture experience? Yes  No

Your professional training:
Acupuncture
Anaesthesiology
Opthalmology
Optometry
Rheumatology
Other  

Please check if you are a member of:
AAMA
AFCI
BMAS
Other medical acupuncture societies


Do you agree not to charge patients who do not get better if you use information from my article, research and communication?
Yes  No
(A Yes response is needed to qualify you as a Priority Provider)

Comment or question:

“Specializing in Difficult-to-Treat Medical Conditions”