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Documents for Patients
Please do this paperwork before your appointment. Thank you for your time, wonderful energy and positive attitude!
Please watch this video, so that you understand what to expect from our work together. Thank you.
https://www.elementsinharmonyacupuncture.com/accountability
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
Acupuncture Rates
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:
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 90 videos!
90. 9th video on Fertility
89. PLACENTA PREVIA Cases
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
82. Loss of Smell, Asthma
81. COSMETIC ACUPUNCTURE
80. Healing Mindset
79. Acupuncture & Menses
78. Multiple Sclerosis
77. Accountability #4
76. Confidence
75. The Reason Why I Became a Healer
74. Restless Leg Syndrome, Foot Pain
73. An's Happy Club
72. Lower Back Pain
71. Accept Yourself for Who You Are
70. Realistic Expectations
69. Anxiety & Insomnia - Linda's Testimonial
68. Stage 4 Kidney Disease; Low Platelet Count; VBAC
67. Remembering Grandmaster Dr. Richard Teh_Fu Tan
66. Eating Disorder
65. Stick with your Commitments
64. Breastfeeding, Working moms, High quality of life
63. Motherhood
62. Be Nice to Pregnant Women
61. Natural Induction (Video #2)
60. Yelp 191: Dry Eye, PMS, Moodiness, Sleep
59. Stretching Forearms
58. Acupuncture is Effective Medicine – Global Movement
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
I have received 239+ Yelp reviews. I love to share my success with my 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!
Anna Dolopo
Gold Level Certified Dr. Tan’s Balance Method Acupuncturist
Ba-Zi Practitioner Dr. Tan Graduate
239+ Yelp Reviews & MANY Testimonials
Proudly serving Southern California since 1999.
Providing Excellence in the field of Chinese medicine!
