Remedy Acupuncture Injury Rejuvenation and Pain Management
with Andy Alzamora in Salt Lake City


The following forms are designed to help us work together more easily. Please fill out these forms before your appointment to have more time for treatment on the day of evaluation.

Informed Consent

Permission to perform acupuncture and other modalities

Evaluation Form

Please fill out these evaluation questions and email them to ( before you arrive for your appointment OR print them and bring them on the day of your appointment. (No need to worry about the temperature and blood pressure section) Thank You :)

formulario de evaluación

Por favor, complete este formulario en internet y luego envíelo por correo electrónico o tráigalo con usted el día de su tratamiento.

Note: To download Adobe Acrobat Reader for free, click here.