Documents for Patients
Please do this paperwork before your appointment.
This paperwork was also emailed to you in word document attachments.
Thank you for your time, wonderful energy and positive attitude!
Please watch these videos, so that you understand what to expect from our work together. Thank you.
https://www.elementsinharmonyacupuncture.com/accountability
https://www.elementsinharmonyacupuncture.com/expectations-acupuncture
First document:
PATIENT NAME
Please click on my photo below to download the document.
Second document:
5 Elements Symptoms. Please check off any issues that you've been experiencing in the past month.
Third document:
Only for women. If you are a woman of any age, please download this document.
Fourth document:
Consent to treat & Arbitration
Fifth document:
Confidentiality
Sixth document:
Cancellation Policy
Seventh document:
Male Anatomy Photo. Please circle any areas of pain, numbness or health issues.
Eighth document:
Female Anatomy Photo. Please circle any areas of pain, numbness or health issues.
Ninth document:
Community Blankets
Thank you so much for contacting me regarding my services as a Chinese medical practitioner. PLEASE READ THIS ENTIRE DOCUMENT THOROUGHLY.
***See you at your time. No need to come earlier. Please do your best to have your paperwork done prior to your appointment. Thank you.***
Directions:
My address is: 23151 Verdugo Dr., Ste. 114, Laguna Hills 92653
PLEASE FOLLOW THESE INSTRUCTIONS. Your GPS may not lead you directly to my office.
I am 5 minutes off the freeway.
From the 5 freeway, exit Lake Forest and head west. Get on your left lane immediately. Turn left on Del Lago (if you turn right, the name of the street is “Research.”) If you hit Moulton/Irvine Center Dr., you’ve gone too far. Turn right on your first stop sign at La Cadena. La Cadena turns into Verdugo as it curves left. When you are driving on Verdugo, you’ll see the first building to the right that is facing the street. It’s a grayish/tannish building. The trees are covering the building number 23151. Turn right into the parking lot AFTER this first building.
There are 2 entrances. Please enter from the front of the building, which is where the main parking lot is. If you go towards the double doors, you are at the back of the office.
Please call me at 949.305.1703 if you are lost. My cell number is 619.341.4341, so you can also text that number if you’d like.
**You are always welcome to bring ear phones/ear plugs any time you come in for therapy.**
PLEASE PLAN ON BEING WITH ME FOR 1.5-2.5 HOURS DURING YOUR FIRST VISIT. Follow-up visits are a minimum of 45 minutes. You’ll be asked to stay longer if I don’t need the table or if I don’t need to take care of my children. If you need to leave at a certain time, please always tell me at the beginning of your time with me and please put your own alarm on your phone.
***The acupuncture treatment will be given during your initial consultation. It is not an option to pay for the consultation and receive the first treatment without cost on another date. If you have a specific time frame to leave, please inform me at the beginning of our consultation.
PLEASE USE THE RESTROOM BEFORE YOUR TREATMENT. If you have to use the restroom during your treatment, then the treatment is done.
I am grateful for your serious interests in my services as a healer.
Thank you for this wonderful opportunity to help you GRADUATE or, at least, significantly improve all of your health concerns AND guide you along the path of exceptional health.
Please watch our 221 videos! These are listed from most recently posted.
Please subscribe to our new YouTube channel.
221. Defeat does not have to define you
220. Do acupuncture needles hurt? - Dr. Shohreh Omidi
219. Do you suffer from migraines/headaches?
218. Fertility circle & qi gong 2/23/27
217. Natural fertility despite 4 failed IVFs and 5% chance to get pregnant
216. Sperm motility increased from 3% to 72%
215. Dry eye syndrome
214. Back to basics
213. Thank you from our EIH healing team!
212. Sleep & estrogen: Dr. Omidi
211. Dr. Hope Lin
210. Full body stretch
209. Carpal tunnel testimonial: Pam Kaur
208. Acupressure for dry eye: Leilani Navar
207. The Cure for a Dry Vagina
206. Pam Kaur, L.Ac., RN
205. Dancing Doctor
204. Compassion
203. How I've kept my kids healthy
202. Fertility protocol
201. Estrogen and fitness: Dr. Shohreh Omidi
199. Alcohol and estrogen: Dr. Shohreh Omidi
198. Back pain: Leilani Navar, Dipl. OM, L.Ac.
197. Staffordshire bullterrier receives acupuncture
196. Tinnitus can be caused by some pharmaceutical drugs
195. Tremors, dizziness, anxiety
194. Sleep: Leilani Navar, Dipl. OM. L.Ac.
193. Nicole Davidson, LMT introduction video
192. 2 of Dr. Dolopo's most challenging fertility cases
191. Leilani Navar, Dipl. OM, L.Ac., introduction video
190. Estrogen and bowel movements - Dr. Omidi
189. Natural fertility with Dr. Dolopo after mommy experienced 4 failed IVFs prior to working with Dr. D
188. Plastic and hormones - Dr. Omidi
187. Estrogen: Men and Women - Dr. Omidi
186. How to prevent blue balls: part of MEN'S HEALTH series
183. What turns women on?
182. Back pain discussed by Dr. Hope Lin
181. Sleep discussed by Dr. Shohreh Omidi
180. Acupuncture helps people with pain
178. Dr. Shohreh Omidi: Anxiety and Depression
177. What turns women on?
176. Dr. Hope Lin
175. I make babies with Qi Gong!
173. An's Happy Club and Fertility
172. Dr. Shohreh Omidi
170. Sperm motility
169. Congratulations to my mommies!
168. Making a baby takes commitment
167. Acupuncture is POWERFUL medicine!
166. Anxiety
165. Depression, anxiety & other health issues
164. Congratulations to my mommies!
163. Tinnitus
162. Insomnia 2022
160. Acupuncture Research: Allergic Rhinitis, Obesity, Endometriosis, Post-operative pain
159. Endometriosis: Stage 4 - Migraines & Menstrual Cramps
158. Amenorrhea
156. Amenorrhea
155. Take the Pressure Off Yourself: Fertility
154. Post-Infection
152. Libido for Fertility
151. Sex Drive
150. Self-Care & Dating Your Spouse
149. Pain
148. Emphysema
146. Fertility Circle
145. Healing Residual Issues Post-Infection
144. 3 Positive Pregnancies with the POWERS of Chinese Medicine
143. Higher Libido to Make a Baby
142. Breathe
141. Failing Kidneys
140. Serious Women's Health Issues
139. Hormone Imbalance
138. IVF Revisited November 2021
136. Working Women & Infertility Issues
135. Immune System High! Stress Low.
134. Watch Your Posture!
133. 44-year old women conceives naturally
132. Energy Level Up!
131. Successful IVF
129. Migraines
128. Expectations
127. 22 Years of Service
126. Qi Gong Research
125. Increase Sperm Quality and Quantity
124. Bell's Palsy
122. Do It Dirty, Baby!
121. Pain
119. Do You Want to Feel Relaxed?
118. Back Pain
117. My Acupuncture Day
116. Do you want to be a mommy or daddy?
115. Improved vision -3.75 to -1.5 Rx
114. Benefits of Qi Gong: Research Studies
113. Powerful Energy
112. Anxiety 2020
111. Brain Hemorrhage and Migraine
110. Covid-19 & its Health Impact on Overweight & Obese Patients
109. Solution-based Acupuncture: Preventing Miscarriages
107. Qi Gong with An
106. Athletic Injuries
104. Protect Your Throat
103. Acupuncture with IVF and IUI
102. Qi Gong on the Beach with Anna
101. Gift
100. Logistics
98. Insomnia, Irregular Menses, Weightloss
97. Foot & RLS
96. Wrist
95. Bacterial Vaginosis, Tinnitus, Depression, Shoulder & Wrist Pain
94. Bell's Palsy & 25 Other Topics
93. Protecting Ourselves During COVID-19 at our Healing Center
88. Anxiety, Depression, Pain, Women's Health
87. Herniated Disc
86. Lupus & Balance Method Acupuncture
85. Neck Pain; Pre-surgical Pain; Back Pain
84. Torn Hamstring
83. Improved Vision, Enlarged Thyroid, Neck Pain
80. Healing Mindset
79. Acupuncture is Safe during Menses
76. Confidence
75. The Reason Why I Became a Healer (old YouTube channel)
74. Restless Leg Syndrome, Foot Pain
73. An's Happy Club ($100 a month: All HC videos & 1 acupuncture treatment monthly, which includes a private 10-minute consultation. This is a subscription program.)
72. Lower Back Pain
71. Accept Yourself for Who You Are
69. Anxiety & Insomnia - Linda's Testimonial
68. Stage 4 Kidney Disease; Low Platelet Count; VBAC (old YouTube channel)
67. Remembering Grandmaster Dr. Richard Teh-Fu Tan
66. Eating Disorder
65. Stick with your Commitments (my old YouTube channel)
64. Breastfeeding, Working moms, High quality of life
63. Motherhood
61. Natural Induction (Video #2)
60. Yelp 191: Dry Eye, PMS, Moodiness, Sleep
58. Acupuncture is Effective Medicine
57. Pikachu
56. Chris McGarahan, Jr.
55. Dr. Lynn McPhearson
54. Dr. Soon Lee
53. Martial Arts
52. Bishop gets Acupuncture
51. Anxiety 1/4/2017
50. Increase SEX DRIVE 1/3/2017
49. DO IT NOW
48. 7th Video on Natural Fertility
47. The POWER of Believing You’re UNSTOPPABLE
46. Anna Dolopo
45. Severe Depression, Anxiety, PTSD, Panic Attacks
44. SEVERE PMS, Exhaustion, Digestive Issues, Headaches, Dizziness
43. Bilateral Morton’s Neuroma
42. ACCOUNTABILITY part 3
41. Martial Arts for Special Needs Kids
40. Neck and Shoulder Pain due to Jiu-Jitsu Injury
39. 5 BIG Testimonials: GERD/Nexium; Neck & Shoulder Pain; Hormonal Imbalance; Bell’s Palsy X 2 cases
38: 8-year old with ADD/ADHD, neck tics/pain & bedwetting
37. ACCOUNTABILITY part 2
36. Self-worth
35. Insomnia
34. SEVERE PAIN
33. Knee pain; Amenorrhea; Sadness; MARTIAL ARTS & EMPOWERMENT FOR GIRLS & WOMEN
32. Knee pain and Acupuncture
31. ACCOUNTABILITY (my standard protocol for success in treating any type of issues)
30. Inducing twins at 37 weeks: medical necessity
29. Jaundice/Itching/Sleep
28. PCOS/Regulating Hormones
27. Hypertension
26. Complete Placenta Previa
25. Labor and Delivery (parts 1 and 2)
24. Natural Fertility – Testimonial from a religious patient
23. Natural Fertility – 6 brief cases
22. Natural Fertility – more babies!
21. Sexual abuse
20. Headaches and Migraines
19. Natural Fertility, Threatened Miscarriage
18. Cysts on wrist, knee and spleen
17. Immune System (parts 1, 2 and 3)
16. Libido (parts 1 and 2)
15. Breech presentation
14. Digestive issues
13. Neck pain
12. Fulfilling our dreams (parts 1 and 2)
11. Anxiety & Saving Tonsils
10. Weightloss
9. Placentia Previa
8. Depression
7. Ankle Pain
6. PCOS & Natural Fertility
5. Stop Smoking & No more Type II Diabetes
4. Fertility after multiple miscarriages
3. Guillain-Barre
2. Anxiety
1. Sciatic pain
We have received 292+ Yelp reviews and more testimonials. We love to share our successes with our patients to inspire hope, confidence and determination for a happier, healthier world. Thank you so much for this wonderful opportunity to serve you.
Make sure that you have eaten a meal. Do not consume any caffeine prior to your treatments (if you can help it), so that you can receive the full relaxation benefits of the treatment. Do not come in to your treatment hungry. Drink plenty of water throughout the day before you come in. DO NOT DO ANY RECREATIONAL DRUGS OR DRINK ANY ALCOHOL ON THE DAY OF YOUR ACUPUNCTURE THERAPY. These requests to eat prior to your treatment are VERY IMPORTANT.
I am here to listen to you as a healthcare professional. I hope you have really high expectations from me because I expect to exceed whatever it is you want for us to achieve together. Thank you for your time, energy and patronage. It is my great pleasure to serve you.
Your Healing is Our Success!
I wish you Greatness!
Dr. Anna Navida Dolopo, DACM, Dipl. OM, L.Ac.
Doctor of Acupuncture & Chinese Medicine
California Licensed and National Board Certified Acupuncturist
Gold Level Certified Dr. Tan’s Balance Method Acupuncturist
Ba-Zi Practitioner Dr. Tan Graduate
292+ Yelp Reviews & MANY Testimonials
Proudly serving Southern California since 1999.
Providing Excellence in the field of Chinese medicine!
