Jan: The Intake Form
I was hoping that TCM could provide some immediate relief,
or at least prevent my headache from becoming worse. I brought
a completed intake form to the office that the staff had sent
to me earlier.
The
intake form
I was offered a cup a chrysanthemum tea to sip on while the
practitioner, Anna, took a few minutes to read through the
intake form.
Chrysanthemum
tea
Move your mouse over the blue text.
When done, click the forward arrow to continue.
|
Jan brought a completed intake form to the visit.
|
- General information about Jan
- Jan's medical history
- Any medications, herbs, or supplements she is
currently taking
- Jan's description of the nature of her migraines,
in her own words
- Information about Jan's general state of health
(level of energy, general emotional state, sleep
patterns, diet and digestion, menstrual cycle, physical
range of motion)
- Information about Jan's lifestyle (her livelihood,
any stresses incurred by her work, her living environment,
and relationships in her life)
|
| Chrysanthemum is a pleasant, caffeine free herbal
tea, long used in China to offer relief from certain
patterns of headache. |
|
|
|
|