New Patient Intake Form - Traditional Chinese Medicine

Please provide the requested demographic and administrative information, following which you will be asked to provide signs and symptoms that help us organize your condition(s) into a traditional Chinese medicine (TCM) pattern diagnosis. There may be some overlap across clinical sections. It is important that you be thorough but also focus on your primary health concern. Be sure to complete all required fields. At the end of the form, follow the instructions to return the form electronically to HealthPoint.

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