Acupuncture Intake Form - Big Table

Acupuncture Intake Form: What Is It?

An Acupuncture Intake Form is a document used by acupuncturists to collect information about a patient's health history, lifestyle, and current condition. This form is used to help the acupuncturist develop an individualized treatment plan for the patient.

Typical acupuncture practices include the insertion of thin needles into specific points on the body to stimulate the flow of energy and promote healing. Other practices may include the use of heat, electrical stimulation, moxibustion (the burning of herbs), cupping as well as a series of traditional massages. In some cases, these methods are used in combination of one another.

An acupuncture intake form typically requests information such as:

• The patient's medical history;
• A list of current medications that the individual is taking;
• The lifestyle habits of the individual including details about their diet;
• Information about sleeping patterns. How well the individual sleeps, how many hours on average the person sleeps for and the quality of their sleep;
• Any current symptoms that the patient may be experiencing which are not just limited to the location of the pain;
• The form will also ask about any prior acupuncture treatments that the patient experienced and the results of the treatment. In addition, a medical professional may also request to know the patient's expectations for the treatment.

However, the main aim of the form is not simply to just collect important information about a patient's health history and current condition. The information obtained in the form can be used to create a personalized treatment plan and to help the acupuncturist better understand the patient's needs. The intake form also serves as a legal document that can be used to protect the acupuncturist in the event of a malpractice claim.

An Acupuncture Intake Form template can be downloaded by clicking the link below.

Still looking for a particular form? Take a look at the related forms below:

• Patient Intake Form;
• Hospital Admission Form;
• Massage Intake Form.