Acupuncture Intake Form

Form Template

If you are an acupuncturist or manage a spa where acupuncture treatment is administered, the Acupuncture Intake Form Mobile App is a necessity!

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Language: English
Country: United States of America

This app provides everything an acupuncture practitioner needs before beginning acupuncture treatment on a new patient. Download this form to your smartphone, iPad or other tablet today to ensure you address your patients symptoms and/or pain issues.

As acupuncturists, use this acupuncture intake form template to enhance patient intake procedures as method of informed consent at the time of the first appointment. Use this client intake form to understand the health of your client and any medical condition that could impact treatment or cause reactions to treatment as part of his or her medical history.

This app can easily be customized to meet the needs of your acupuncture clinic. Include different types of acupuncture treatment and other services related to traditional Chinese herbal medicine. This intake form includes a full list of potential symptoms patients may present with including: joint pain, sleep issues such as trouble falling asleep, dry skin or other skin issues, or GI issues that could affect weight loss.

Let the client know they may be slightly sore after the treatment and may experience minor pain, possible bleeding at the site of treatment, and a risk fainting. On the flip side, some patients may experience sudden energy bursts.

Having a real-time record of a patient's health right at your fingertips will help improve your customer satisfaction and bring clients back for their next treatment. Each and every acupuncture intake form is saved safely and securely to your business's GoCanvas Cloud. Quickly and easily access the information for review each time you treat a client.

Capture data electronically with this and our other holistic medicine mobile forms.

  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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