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A.R.T. Allergy Release Technique®
Acupuncture
Chinese Herbs
Back
For A.R.T®
For Other Services
Services
A.R.T. Allergy Release Technique®
Acupuncture
Chinese Herbs
Booking
For A.R.T®
For Other Services
FAQ
About
Insurance & Fees
Contact
To find out if Allergy Release Technique® is the right fit for you,
email Julie
for an initial appointment or phone consultation. Alternatively, you may fill out the form below.
Your Name
*
First Name
Last Name
Child's Name (if applicable)
First Name
Last Name
Child's Age (if applicable
Email
*
City/Town
Phone
(###)
###
####
Current Allergies and Health Issues
Please include SKIN TEST results and RAST numbers from testing within the last year
List each allergen along with SKIN TEST results and RAST number (please include the Total IGE level for RAST test).
Have you (or your child) had an anaphylactic reaction? If yes, please explain (include dates)
If an EpiPen was used during treatment of this reaction, please include that information.
Have you (or your child) been prescribed an EpiPen?
Additional Details Related to Current Health Issues
Thank you for your submission.
