245 at The Circle Family Center, Sea Ridge Road, Aptos, CA

phone: 831.818.7051

Live Oak Acupuncture & Healing Arts

Dr. Marcia Connelly, DTCM, LAc, Dipl.OM


Pregnancy Information • Claudia Citkovitz

Pregnancy and Fertility • Debra Betts

Acupressure • Debra Betts


Choose the appropriate link below and “save as” to your computer where you can find it.  “Right click on a PC” or “control click” on a mac in order to download the pdf file to your computer. The form can be filled out in Acrobat Reader. Once completed please email to: mcherbgal@gmail.com

General Intake Form

Women’s Health Assessment

Men’s Health Assessment

Pediatrics Form

Directions for submitting the intake forms

  1. If you don’t have acrobat reader, follow this link to download it to your computer.
  2. Once the form is on your computer, fill it out completely and email it to Marcia: mcherbgal@gmail.com
  3. If you prefer, and have a printer, feel free to complete the form, print it out and bring it with you.
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