Forms

We ask that you complete a short medical history intake form (Medical Intake Form). This enables us understand your current symptoms and past history. For more complex issues and for internal medical conditions, we ask that you also complete a second slightly longer Chinese medicine intake form (Self Assessment Profile). This helps us to more accurately understand your unique situation and to prescribe customized herbal preparations. To save you time and to help you understand your unique signs and symptoms from both a western medicine and Chinese medicine perspective, both the short intake and self assessment profile forms can be completed prior to your visit. If you experience any trouble downloading these files, please contact us.

Please print out form, fill out, and bring in for your scheduled appointment.
If you are not able fill out before hand, please arrive 15 minutes before your appointment.

We highly recommend your completing both intake forms and reviewing the educational information on this website prior to your first visit.

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