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Daniel O'Neill, Lac The Center for Natural Medicine 1330 SE Cesar E Chavez Blvd (39th), Portland, OR 97214 (503) 232-1100 fax (503) 232-7751 www.cnmwellness.com ACUPUNCTURE INTAKE QUESTIONNAIRE This

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How to fill out acupuncture intake questionaire

To fill out an acupuncture intake questionnaire, follow these steps:

01

Begin by reading through the questionnaire carefully. Take your time to understand the questions and what information is being requested.

02

Start filling out the personal information section first. This may include your name, address, date of birth, contact details, and insurance information if applicable. Remember to provide accurate and up-to-date information.

03

Next, move on to the medical history section. Answer all the questions honestly and thoroughly. It's important to include any previous illnesses, surgeries, or medical conditions you have or have had in the past. This information helps the acupuncturist to better understand your health background and tailor their treatment accordingly.

04

Pay attention to any specific concerns or symptoms related to the reason you are seeking acupuncture treatment. Write down any details, such as the duration, intensity, and triggers of your symptoms. This will assist the acupuncturist in identifying the right course of action.

05

If you are taking any medications or supplements, make sure to provide a complete list along with the dosages. This includes prescription medications, over-the-counter drugs, herbal remedies, and vitamins. It's significant for the acupuncturist to know if there are any potential interactions or contraindications.

06

Fill out the lifestyle section, which may inquire about your diet, exercise routine, sleep patterns, stress levels, and any other factors that might be impacting your overall well-being. Be as specific as possible to help the acupuncturist gain a comprehensive view of your lifestyle.

07

Finally, review your answers to ensure accuracy and completeness. If you're unsure about any questions, don't hesitate to ask the acupuncturist for clarification.

Who needs an acupuncture intake questionnaire?

An acupuncture intake questionnaire is typically required for all individuals seeking acupuncture treatment. It allows the acupuncturist to gather essential information about the patient's health history, symptoms, and lifestyle factors. Whether you are a new patient or have been receiving acupuncture for a while, the intake questionnaire helps ensure that the treatment plan is personalized and tailored to your specific needs. Additionally, the questionnaire assists the acupuncturist in identifying any potential contraindications or precautions that need to be taken into consideration during the treatment process. Overall, the acupuncture intake questionnaire is beneficial for both the patient and the practitioner to ensure optimal care and positive treatment outcomes.

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What is acupuncture intake questionaire?

Acupuncture intake questionaire is a form filled out by patients prior to receiving acupuncture treatment. It includes questions about the patient's medical history, current symptoms, and goals for treatment.

Who is required to file acupuncture intake questionaire?

Patients who are seeking acupuncture treatment are required to fill out the acupuncture intake questionaire.

How to fill out acupuncture intake questionaire?

Patients can fill out the acupuncture intake questionaire by providing accurate and detailed information about their medical history, current symptoms, and treatment goals.

What is the purpose of acupuncture intake questionaire?

The purpose of the acupuncture intake questionaire is to help acupuncturists assess the patient's health condition, create a treatment plan, and track the progress of the treatment.

What information must be reported on acupuncture intake questionaire?

Patients must report their medical history, current symptoms, medications they are taking, allergies, lifestyle habits, and goals for acupuncture treatment.

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