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Acupuncture Intake Form Mobile App

The Acupuncture Intake Form mobile app provides everything an acupuncture practitioner needs before beginning acupuncture treatments on a new patient. Save time and money by getting rid of paper medical acupuncture intake forms for acupuncture services. The app is easily accessible from your smartphone or tablet and can be customized to meet the needs of your acupuncture clinic. The app tracks different types of acupuncture treatments and other services related to traditional Chinese medicine for individual patients and stores them electronically for your records.

Perfect for small acupuncture clinics and for private acupuncture practices, the electronic intake form collects the patient information and details about their pain levels, emotional well-being and current health care. Having a real-time record of a patient's health right at your fingertips makes it easy to track how much pain relief is needed, which acupuncture points are the most effective and which herbal medicine supplements are recommended.

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

  • Lendlease
  • The Cooperative
  • PG&E
  • Toys R Us
  • Red Bull
  • Mirvac

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Take a peek inside the Acupuncture Intake Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Important: Complete this document as thoroughly as possible.

  • Ico date

    Date

  • Ico textbox

    Name

  • Ico multiline

    Address

  • Ico textbox

    Home Phone

  • Ico textbox

    Cell Phone

  • Ico textbox

    Work Phone

  • Ico textbox

    Email

  • Ico dropdown

    Preferred method of contact

  • Ico integer

    Age

  • Ico date

    Date of Birth

  • Ico textbox

    Place of Birth

  • Ico dropdown

    Gender

  • Ico dropdown

    Marital Status

  • Ico textbox

    Height

  • Ico textbox

    Weight (lbs)

  • Ico textbox

    Occupation

  • Ico textbox

    Employer

  • Ico integer

    Hours worked per week

  • Ico dropdown

    Is your health complaint related to work?

  • Ico multiline

    How did you hear about our office?

  • Ico textbox

    Guardian (if under 18)

  • Ico textbox

    Person to notify in an emergency

  • Ico textbox

    Relationship

  • Ico textbox

    Emergency Contact Phone

  • Ico multiline

    Major Complaint(s), in order of significance to you

  • Ico multiline

    How do these conditions impair your daily activities?

  • Ico multiline

    How was your childhood health?

  • ...and More!

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