Patient Intake Form

Ok. Here it is. A Traditional Chinese Medicine intake form. Because this medicine is holistic there are more questions than found on your regular medical questionnaires. In order for you to receive the best care and evaluation for your needs the form is detailed. It is best to complete the form at least a day before your first meeting with Christopher. This way you get a chance to reflect on what is going on with you physically, emotionally, mentally and spiritually, The whole picture. And you will record things you might forget if you walk into the clinic hoping to remember everything. Yes, it is homework. Homework for your healthy future.

2015 TCM Intake Form