New Patient Intake Form

Please check the box that best represents how frequent you feel your chief complaint(s)
When you are feeling your symptom, how long you your symptoms last?
1. Just want to get some relief from your symptoms, and them you’ll manage the rest with medications(s)
2. Want to Find and Correct the Root Cause of your Health problem(s), it possible, and Re-train your body to heal itself so that you can be less dependent on medications
3. Other
(please take your time and don’t sell yourself short)