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New Patient Forms

Please complete the 4 forms below for your first appointment

(Copies are also available at the office):

  1. New Patient Forms
  2. Informed Consent Form
  3. Privacy Acknowledgement Form
  4. HIPPA Form

Thank you!

Contact Us

  • Email
    adam@gloyeskeacupuncturepointe.com
  • Phone
    513-401-0468
  • Address
    5958 Fairfield Road
    Oxford, OH 45056

    1030 Xenia Avenue
    Yellow Springs, OH 45387
    Yellow Springs Healing Center

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Office Hours

  • Oxford Location:

Tuesday, Wednesday, & Friday: 10 AM – 6 PM

Saturday : Community Appointment Only

  • Yellow Springs Location:

Monday & Thursday: 10 AM – 6 PM

Sundays: All Locations Closed

If you need an appointment before 10 AM or after 6 PM, I will work with you!

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