HealthPoint Traditional Chinese Medicine Intake Form

Clicking the link above will open HealthPoint's Interactive Intake Form to your screen.   By completing the form ahead of your first appointment, you provide HealthPoint with basic information about you, including information about your health concern(s).

You'll notice that our form differs a bit from typical medical intake forms. Once we receive the completed form, we organize your health related items into one or more TCM patterns. Patterns are the methodology by which HealthPoint develops an acupuncture and/or Chinese herbal medicine treatment plan for you. So it is important that you take the time to be complete and accurate.


The information that you provide on the form becomes part of your medical record at HealthPoint. It is stored on a secure server that adheres to the standards for patient privacy in the Health Insurance Portability and Accountability Act (HIPAA). This is your information and copies of it are available to you at any time upon request.


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