問 What brings you in
Tick anything you'd like the practitioner to focus on. We will follow up with the broader picture in the room — this just gives us a place to begin.
痛 Back / neck / joint pain
頭 Migraine / headaches
眠 Insomnia / sleep
慮 Anxiety / stress
經 Menstrual / PMS
孕 Fertility support
脾 Digestion / IBS
皮 Skin · eczema, acne
免 Recurrent colds
神 Burnout / unsettled
傷 Sports / injury rehab
他 Something else
In your own words — what would you like to change?
身 Health background
A quick scan of how the body is currently running. The classical four — sleep, digestion, energy, cycle — tell us a lot. Skip anything that doesn't apply.
Current medications & supplements
Surgeries, hospitalizations, major diagnoses
Pregnant or trying? No Currently pregnant Actively trying Postpartum
Insurance Out-of-pocket FSA / HSA card PPO superbill (will reimburse self) None / sliding scale
Pacemaker or implant? No Yes — please ask in session
擇 Practitioner & time
Choose a practitioner if you have a preference, or let us match you. We will reach out within one business day with two specific time options that fit your availability.
Day-of-week preference Any weekday Mornings only Afternoons only After 5 p.m. Saturday morning
How soon would you like to start? This week Within two weeks Within a month Just gathering info
I understand that the information above is reviewed only by my practitioner and the front desk, that records are kept under HIPAA, and that Your Business will contact me within one business day to confirm an appointment time. 静