New Patient Intake Form

This form does need to be filled out before your first appointment regardless of whether or not you are an existing patient.

PLEASE NOTE: If we were to go through these questions with you in person, it would take around 30 minutes. After that, we go through further tests (such as pulse, face, palm, ear, tongue diagnosis or thermal scan) followed by a discussion of the findings and recommended treatment plan.

By filling this form, you save around 30 minutes of our time which we would otherwise need to charge you for, resulting in significant savings to you. That is why we created this detailed form; all the questions on this form are questions we would otherwise ask in the initial exam. Now you can answer all these online without any cost.  After that your in person exam will just take 30 minutes and cost only $40.  If you are an ACC patient, your surcharge will remain the same for each treatment, but you will receive a longer initial treatment due to the time saved by filling this form in online.

If you have any trouble with the form, please call reception on 07 846 7956 or reply to this email for assistance. Thank you for your patience.