Medical Evaluation forms ensure we capture your health issues and concerns so that we can appropriately discuss options to assist you to reach your optimal health.  Additionally they allow us to monitor and demonstrate your progress.  Prior to your appointment, we ask that you answer some questions about yourself. The questionnaires are below for your convenience.  Click the links to download the appropriate form, print it out, complete it and bring it with you to your initial consultation.

Prior to your appointment, we ask that you answer some questions about yourself. The questionnaires are below for your convenience.  Click the links to download the appropriate form, print it out, complete it and bring it with you to your initial consultation.

Medical Evaluation Patient Intake Form Holistic Homeopathic Acupuncture Massage Herbal Traditional Chinese Natural Medicine Center Lakeland Central Florida

General Patient Forms

If this is your first time coming in to the clinic we will send you a link to fill out an electronic form via docusign after your appointment is scheduled.  These forms are also available in our office. 

If you are interested in hormone replacement therapy, you can bring any of the following records to your first visit:

  1. Mammogram or Breast thermography report within that past year.
  2. Pap Smear report within the past 2 years 
  3. Hormone lab testing and CBC with diff blood test report within the past 6 months.