Forms and resources

Please Note! Due to the high volume of irritating spam and slow-down of participation here, we are no longer accepting new comments, questions, or subjects on this Forum. We are keeping all the subjects and comments for review as there is a lot of good stuff here relating to practice-building subjects. So, dig deep! Thanks to everyone who participated here but it is time to move on to bigger projects educating the public about acupuncture! Matt Bauer

04-Aug-2013 09:37 PM


Posts: 0

I am a new acupuncturist and I have been in search of an intake form that is detailed and provides me with a good outline I can follow when I am doing an initial interview with a new patient.  I am wondering if you would be willing to share with me a copy of your intake form.

Also, do you have a form you use when doing nutritional and/or herbal consults with patients separate from your intake form? I have been hunting for a template I can follow when discussing dietary habits and prescribing herbal medicine to help me establish my diagnostic skills.

Lastly, I am looking for sources, either books or internet sources, that will give me deeper insight and guidance on diagnosing using interrogation.  I often feel like I miss questions while I am interviewing my patients or I get too wrapped up in one aspect of their health and miss the big picture.  I have the basic foundations texts required when I was in school like chinese acupuncture and moxibustion, foundations of chinese medicine, fundamentals of chinese medicine but I feel like these texts are very broad and lack guidance on developing solid interrogation skills.  

Thank you for your help!  



17-Jan-2014 08:01 AM


Posts: 12

My history form is available at my website if anyone wants to look at it.  It’s modeled very closely on the one that we used at school, but I like it because I can tell at a glance if I need to do much of a systems review, and where to focus my time.  I’ve just redone my initial intake and followup forms to include the necessary prompts so I’ll have all the documentation needed to meet E&M standards.  Just email me if you’re interested.  The website is

Leah Olson “Example is not the main thing in influencing others. It is the only thing.” –Albert Schweitzer


17-Jan-2014 08:29 AM

Matthew Bauer

Posts: 211

Leah – thank you so much for sharing these forms. I especially like the symptom range on a good, average, and bad day as that is part of what I teach about monitoring progress. I hope others will share here also be it forms or anything else others could benefit from.  

Matthew Bauer