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Patient Forms

Health History Questionnaire - A comprehensive medical evaluation takes place at your first appointment. Please complete the Health History Questionnaire and bring it with you. This information provides critical detail that helps to develop a diagnosis and treatment plan for you.
Click here to download the form (.pdf)

Notice of Privacy Practices (HIPAA) - This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.
Click here to download the form (.pdf)

Robert P. Surabian, M.Ac.
Licensed Acupuncturist


Jewelers Exchange Building
333 Washington Street, Suite 329
Boston, MA 02108


By appointment only
Monday 12 - 6
Tuesday 12 - 6
Wednesday 12 - 6
  Thursday 12 - 6