Contact Me — Alina Rehkopf

CONTACT

Got something very specific you want to know about? Ask away! I’ll get back to you within 24 hours.

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First Name

Last Name

Subject

Message

REFERRAL

If you are a healthcare practitioner and want to refer a patient to my services, please fill out the fields below.

I will confirm receipt of the referral within 1 business day.

Practitioner Name

First Name

Last Name

Practitioner Type

Practitioner Contact Info

Patient Name

First Name

Last Name

Patient Contact Info

Brief Description of Condition / Diagnosis

Please limit any sensitive patient information. Relevant documents can be presented in person or emailed via password protected PDF to info@alinarehkopf.com.

Traditional Chinese Medicine Modality Being Requested

Acupuncture

Cupping

Herbal Medicine

Guasha

Tuina Massage

Moxibustion

At your discretion

Additional Notes