Please print, complete, and bring the following forms with you on your first visit with us for acupuncture treatment.
Acupuncture New Patient Questionnaire
The downloadable forms are in PDF format. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.
WONDERFULSteven is amazing, I have been going to see him for a year and a half for various reasons, he always delivers positive results. As a health care professional myself, trust him completely! Highly recommend!
COLLEEN, PLAINFIELD, IL
ANXIETYI have been using acupuncture for anxiety that is hormone related. I love it! It calms me and it after I have gone 3 or 4 times It keeps all my symptoms at bay so I go occasionally for a quick tune up. Works like a charm and I don't have to take any medicine. What could be better? True Believer!
LEANNE, PLAINFIELD, IL
ACID REFLUXMy reflux is so much better! I still get symptoms but not like before. I can eat, and I don't have reflux every day. Also my PMS is much more manageable and my cycles are more predictable. Steven Vasilakis is a wonderful acupuncturist! Very professional, thourough and kind! Thanks You, Steven!
MONIQUE, CREST HILL, IL
KNEE PAINI have had type one diabetes for 33 years. Along with the diabetes I have the complications of heart disease, thyroid disease, neuropathy and depression. I have suffered from all over body aches and knee pain for a few years. I went to Steven as last resort and now he is the first one I go to. He was able to start by reducing the pain and now it is no longer an everyday struggle. I have never felt pain free like I do now! He is miracle worker!
LIZ, PLAINFIELD IL
HERNIATED DISCI am back to running 10 miles a day on my weekend runs. I sleep soundly, no more anti-inflammatory meds. I can stretch easily and have no pain in the morning. I Highly recommend Steven! This was my last attempt before surgery - I am very happy with the results!
DAN, PLAINFIELD, IL
LOWER BACK PAINI've seen Steven a number of times, specifically when my back was the worst. His ability to focus on the troubled area and offer treatment without medicine is almost a miracle. He's followed up with me after treatments and advise ways to better treat myself. I'm a big fan, and would advise others to check him out.
WALT, PLAINFIELD, IL
ALLERGIESI have been suffering from seasonal allergies (grass, trees, pollen, ragweed) for several years and decided to try accupuncture. The results have been amazing and I am no longer dependent on allergy medication and shots. The last 4 months, I have had appointments with Steven Vasilakis and he has helped make the spring allergy season much easier to deal with. For those of you with allergies, try accupuncture it really works. I am so impressed with the results.
LYNEE, PLAINFIELD, IL
INFERTILITY Thank you for all your help. You're a big reason we're enjoying our little miracle. JEANETTE, CHICAGO, IL
COSTALGIAMy 18 year old son received 3 acupunture treatments from Steve V to help relieve pain he had been experiencing for a year following surgery. (Nuss procedure) Acupuncture was one possible option for pain management. I was skeptical but was amazed at the results. My son felt some relief after the first session and considerably better after the 3 treatments. 2 months following treatment he is pain free. Appointments were always on time, the office was neat and clean. I recommend seeing Steve to help with any type of pain relief.
A.G, NAPERVILLE, IL
MIGRAINE HEADACHESSteven has helped me with my migraines on two seperate occasions. Two years ago was the first time I started going and the migraines went from two times a week of a dark room and vomiting to manageable slight headaches. I stopped going and the migraines returned in about six months. I have returned to getting treatments and again the headaches have gone away. You never realize the quality of life you are giving up when you suffer from reoccurring headaches. Steven has helped me manage the migraines through acupuncture and my stress level has also improved. Thanks Steven.
TIM, PLAINFIELD, IL
SCIATICA/LOWER BACK PAINPain subsided after two treaments and was gone after five or six This was two years ago and I have had no problem with sciatic pain and very little lower back pain ever since.
SHARON, PLAINFIELD, IL
