Traditional Chinese Medicine Medical History
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Traditional Chinese Medicine Medical History
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This Traditional Chinese Medicine medical history form provides a thorough assessment framework for TCM practitioners, acupuncturists, and integrative medicine clinics. It collects information according to TCM diagnostic principles including the Eight Principles (Yin/Yang, Interior/Exterior, Hot/Cold, Excess/Deficiency), Five Element constitutional types, and organ system patterns. The form documents patient observations of tongue coating, body temperature sensations, sweating patterns, sleep quality, digestive function, emotional states, and other signs critical to TCM pattern differentiation and treatment planning.
Designed specifically for practices incorporating acupuncture, Chinese herbal medicine, cupping, moxibustion, and Tui Na massage, this form goes beyond conventional medical history to capture lifestyle factors highly relevant to TCM diagnosis. It includes detailed questions about diet preferences, reactions to weather and seasons, menstrual cycle characteristics for women, stress patterns, and previous responses to acupuncture or herbal formulas. The form also documents current Western medicine diagnoses and medications to ensure safe integration of TCM treatments with conventional care, supporting a truly integrative approach to patient wellness.
What's included
- Chief complaints and health goals
- TCM constitutional type assessment
- Tongue appearance and coating description
- Pulse quality characteristics
- Temperature and sweating patterns
- Sleep quality and dream patterns
- Digestive function and appetite
- Emotional state and stress levels
- Pain location and quality description
- Menstrual cycle details (if applicable)
- Previous acupuncture and herbal medicine experience
- Dietary preferences and restrictions
- Seasonal symptom variations
- Current Western medications and diagnoses
- Allergies to herbs or substances
- Lifestyle and exercise habits
Who uses this template
- Traditional Chinese Medicine clinics
- Acupuncture and Oriental medicine practices
- Integrative medicine centers
- Holistic wellness clinics
- Chinese herbal medicine practitioners
All form fields
10 fields across 3 pages. Customize any field after signing up.
How to use the Traditional Chinese Medicine Medical History
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Traditional Chinese Medicine Medical History from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Traditional Chinese Medicine Medical History in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 19 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Traditional Chinese Medicine Medical History HIPAA compliant?
Yes. All Formisoft templates, including the Traditional Chinese Medicine Medical History, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 19 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Traditional Chinese Medicine Medical History is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Traditional Chinese Medicine Medical History for your practice. Set up in minutes.
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