Gua Sha & Traditional Chinese Medicine Intake Form

Streamline Your Traditional Chinese Medicine Practice with Paperform

Whether you're a licensed acupuncturist, gua sha practitioner, or holistic wellness center offering traditional Chinese medicine (TCM) services, this intake form is designed to capture the detailed constitutional assessment you need—without the paperwork headaches.

Traditional Chinese medicine requires a nuanced understanding of each patient's unique constitution, lifestyle patterns, and presenting symptoms. This Gua Sha & TCM Intake Form guides patients through a thorough self-assessment covering tongue characteristics, pulse quality, dietary habits, sleep patterns, emotional wellbeing, and specific health concerns—all the foundational information you need before your first session.

Built for TCM practitioners and wellness centers

This template is ideal for:

• Acupuncturists and TCM clinics conducting comprehensive intake assessments
• Gua sha specialists gathering constitutional information before treatment
• Holistic wellness centers offering integrated TCM therapies
• Massage therapists incorporating Eastern medicine modalities
• Naturopaths and integrative practitioners working with TCM principles

Capture the full picture before patients arrive

The form walks patients through constitutional questions about their tongue appearance, pulse sensations, energy levels, digestive health, sleep quality, pain patterns, and emotional state—helping you prepare for more effective consultations. It also includes treatment protocol consent and contraindication screening, ensuring you're practicing safely and within scope.

Connect to your practice management system

Use Stepper to automatically send completed intake forms to your EMR system, trigger appointment confirmation emails, add patients to your CRM, and create follow-up task reminders for your team. Keep your entire patient journey connected and compliant, without manual data entry.

With Paperform's GDPR compliance, secure data handling, and professional design options, you can offer patients a welcoming digital experience that reflects the care and attention you bring to your practice. Customize fonts, colors, and imagery to match your brand, and embed the form directly on your website or share via a custom link.