Acupuncture Clinic Patient Intake Forms: What TCM Practitioners Actually Need

Why Do Acupuncture Clinics Need Specialized Intake Forms?

Quick answer: Generic medical intake forms miss the diagnostic information TCM practitioners actually need. Your intake should capture constitutional patterns, lifestyle factors, and symptom details that inform tongue and pulse diagnosis—not just a list of medications and allergies. The "10 Questions" framework has guided TCM diagnosis for centuries, and your intake forms should reflect that methodology.

Here's the problem most acupuncturists face: you're handed a generic health history form designed for Western medicine, and you end up asking all your real diagnostic questions verbally during the appointment. That first visit stretches to 75 minutes, and you're still scrambling to document everything.

The research backs this up. Studies on TCM diagnostic consistency found that questionnaire-based diagnosis significantly improved inter-rater reliability among practitioners. In other words, structured intake forms don't just save time—they lead to better, more consistent diagnoses.

What Makes TCM Intake Different

Western medical intake focuses on:

• Chief complaint
• Current medications
• Allergies
• Past surgical history
• Family history of specific diseases

TCM intake needs all of that plus:

• Constitutional assessment (hot/cold tendencies, energy patterns)
• Digestive function details (appetite, bowel habits, food preferences)
• Sleep patterns (falling asleep, staying asleep, dream activity)
• Emotional patterns (stress response, mood tendencies)
• Sensory symptoms (vision, hearing, taste changes)
• Temperature regulation (sweating patterns, hot/cold sensitivity)
• Pain characteristics in TCM terms (fixed vs. moving, better with heat or cold)

Your patients may wonder why you're asking about their dreams when they came in for back pain. A well-designed intake form normalizes these questions and primes patients for the holistic nature of TCM assessment.

What Health History Questions Do TCM Practitioners Need?

Quick answer: TCM health history should follow the classical "10 Questions" framework: chills and fever, perspiration, head and body, bowel and bladder, diet and appetite, chest and abdomen, hearing, thirst, previous illnesses, and causes/onset. Modern intake forms should also capture sleep, energy, emotional state, menstrual history (if applicable), and lifestyle factors that inform constitutional diagnosis.

The TCM "10 Questions" Framework

This diagnostic framework has been used for centuries and remains the foundation of TCM inquiry. Your intake form should systematically capture:

1. Chills and Fever

• Temperature preferences (feeling hot or cold)
• Fever patterns if present
• Response to environmental temperature

2. Perspiration

• Sweating patterns (day vs. night, spontaneous vs. exertion)
• Location of sweating
• Associated symptoms

3. Head and Body

• Headache patterns (location, quality, triggers)
• Body pain characteristics
• Heaviness or fatigue sensations

4. Bowel and Bladder

• Stool frequency, consistency, urgency
• Urination frequency, color, sensation
• Any changes from normal patterns

5. Diet and Appetite

• Appetite level and variations
• Food cravings or aversions
• Digestive symptoms after eating

6. Chest and Abdomen

• Breathing patterns
• Chest tightness or pain
• Abdominal discomfort or bloating

7. Hearing

• Hearing changes
• Tinnitus (ringing, quality, timing)
• Ear-related symptoms

8. Thirst

• Thirst level and preferences
• Temperature preference for drinks
• Dry mouth or excessive salivation

9. Previous Illnesses

• Major health events
• Chronic conditions
• Treatment history (Western and Eastern)

10. Causes and Onset

• What triggered the current issue
• How symptoms developed over time
• Relationship to stress, diet, weather, or other factors

Modern Additions to TCM Intake

Beyond the classical questions, contemporary practice benefits from capturing:

• Sleep quality — Difficulty falling asleep, staying asleep, waking times, dream patterns
• Energy patterns — Time of day variations, post-meal energy, recovery from exertion
• Menstrual history — Cycle regularity, flow characteristics, associated symptoms (for applicable patients)
• Emotional patterns — Stress response, predominant emotions, mood stability
• Lifestyle factors — Exercise, diet patterns, work stress, screen time

What Must Acupuncture Informed Consent Cover?

Quick answer: Acupuncture informed consent must disclose common side effects (bruising, temporary soreness, dizziness), rare but serious risks (pneumothorax, nerve damage, infection), and treatment alternatives. Patients must understand they can refuse or stop treatment at any time. If you offer additional modalities like cupping, moxibustion, or herbal medicine, these require their own specific disclosures.

Required Risk Disclosures

State licensing boards and professional organizations (like the American Acupuncture Council) specify what your consent must cover:

Common side effects:

• Bruising at needle sites
• Temporary numbness or tingling near needling sites
• Minor bleeding
• Temporary soreness
• Dizziness or lightheadedness
• Fatigue after treatment

Rare but serious risks:

• Pneumothorax (lung puncture) — rare but the most significant risk, especially with points on the chest and upper back
• Organ puncture — extremely rare with proper technique
• Nerve damage — uncommon but possible
• Infection — minimal risk with sterile single-use needles, but must be disclosed
• Broken needles — very rare with modern needle quality
• Spontaneous miscarriage — certain points are contraindicated during pregnancy

Treatment alternatives:

Your consent should acknowledge that patients have other options including self-care, over-the-counter pain relief, physical therapy, conventional medical treatment, or no treatment. Patients have the right to a second opinion.

Consent Best Practices

The American Acupuncture Council recommends:

• Go over the consent form verbally with each patient
• Ask if the patient has questions
• Document in the patient record that informed consent was discussed
• Have patients sign before the first treatment
• For existing patients who haven't signed, update their records at their next visit

Your consent should cover the "entire course of treatment for present and future conditions"—but patients must understand they can withdraw consent at any time.

Do You Need Separate Consent for Cupping, Moxibustion, and E-Stim?

Quick answer: Yes. Each modality carries distinct risks that require specific disclosure. Cupping causes visible bruising and carries burn risk with fire cupping. Moxibustion involves heat and smoke with burn and scarring risks. Electrical stimulation is contraindicated for patients with pacemakers. A comprehensive acupuncture consent can include these modalities, but each risk must be explicitly stated.

Cupping Consent Requirements

Cupping is increasingly popular but leaves visible marks that surprise uninformed patients. Your consent should cover:

• Expected bruising — circular marks that may last days to weeks
• Burn risk — especially with fire cupping (glass cups)
• Skin irritation — temporary redness, sensitivity
• Blistering — possible if suction is too strong or duration too long
• Contraindications — skin conditions, bleeding disorders, pregnancy (certain areas)

Some practitioners add photo consent specifically for cupping marks, especially if the patient might share images.

Moxibustion Consent Requirements

Moxibustion (burning mugwort) provides therapeutic heat but carries specific risks:

• Burns and scarring — the primary risk, especially with direct moxa
• Smoke exposure — some patients have respiratory sensitivity
• Fire hazard — proper safety protocols must be followed
• Allergic reaction — rare but possible sensitivity to mugwort

If you use smokeless moxa, heat lamps, or TDP lamps, these should be mentioned as the specific heat source.

Electrical Stimulation (E-Stim) Consent

E-stim added to acupuncture needles requires disclosure of:

• Contraindication with pacemakers/defibrillators — absolute contraindication
• Contraindication with epilepsy — relative contraindication
• Pregnancy considerations — avoid certain areas and frequencies
• Sensation expectations — tingling, muscle twitching
• Skin irritation — at electrode sites if surface electrodes used

Herbal Medicine Consent

If you prescribe or dispense Chinese herbal formulas, you need additional consent covering:

• Herbs may interact with prescription medications
• Proper preparation instructions must be followed
• Quality and sourcing of herbs
• Pregnancy contraindications for many herbs
• Potential side effects (digestive upset is most common)

How Do You Screen for Acupuncture Contraindications?

Quick answer: Your intake must screen for pregnancy (certain points are contraindicated), bleeding disorders or blood-thinning medications, pacemakers or implanted devices (contraindicated for e-stim), infectious diseases, and skin conditions at potential needle sites. Conditional logic in digital forms can flag these automatically and prompt additional questions or provider review.

Absolute Contraindications

These require treatment modification or referral:

Pregnancy

• Certain acupuncture points are contraindicated (especially lower abdomen, lumbosacral, and specific points that move qi strongly)
• All female patients of childbearing age should be asked about pregnancy status
• This question should appear prominently on every intake update

Pacemakers/Implanted Devices

• Absolute contraindication for electrical stimulation
• Needling is generally safe but requires caution near device sites
• Should be flagged immediately in intake

Bleeding Disorders/Anticoagulant Therapy

• Not an absolute contraindication but requires modified technique
• Warfarin, heparin, and newer anticoagulants (DOACs) increase bruising risk
• May affect needle technique and point selection

Relative Contraindications

These require assessment and possible modification:

• Hemophilia or clotting disorders — may require physician clearance
• Severe needle phobia — consider whether acupuncture is appropriate
• Acute infection with fever — typically wait until resolved
• Skin lesions at needle sites — avoid affected areas
• Extreme fatigue or hunger — may increase fainting risk
• Intoxication — postpone treatment
• Recent heavy meal — may affect certain treatments

Smart Screening with Digital Forms

Paper forms show every question to every patient. Digital forms with conditional logic can:

• Ask pregnancy status, then expand to trimester and pregnancy-specific questions only if relevant
• Flag pacemaker patients automatically for e-stim contraindication
• Show blood thinner questions only if patient indicates "yes" to relevant medications
• Alert you before the appointment if any major contraindications are present

This creates a faster intake for most patients while ensuring thorough screening for those who need it.

How Do Patient Intake Systems Compare for Acupuncture Clinics?

Quick answer: Most intake solutions offer generic medical templates that miss TCM-specific needs. You end up rebuilding forms from scratch or supplementing with verbal questions. EasyDocForms offers $49/month flat pricing with white-glove setup—send us your current intake forms or describe your TCM diagnostic framework, and we build digital forms that match your practice methodology.

Feature	EasyDocForms	IntakeQ	JotForm	Jane App
Monthly Price	$49 flat	$49.90+ per provider	$99 (HIPAA tier)	$54-109/month
HIPAA Compliant	Yes (BAA included)	Yes	Only Gold tier	Yes
TCM-Specific Templates	Yes (custom built)	Build yourself	Build yourself	Limited
Cupping/Moxa Consent	Yes	Build yourself	Build yourself	Basic
White-Glove Setup	Yes	No (DIY)	No (DIY)	No (DIY)
Mobile Optimized	70%+ completion rate	Varies	Varies	Yes
Conditional Logic	Yes	Yes	Yes	Yes
E-Signatures	ESIGN/UETA compliant	Yes	Yes	Yes

Why White-Glove Setup Matters for Acupuncturists

You trained in TCM diagnosis, not form building. DIY platforms mean:

• Hours translating the 10 Questions into digital format
• Figuring out conditional logic for contraindication screening
• Building separate consent forms for each modality you offer
• Ongoing maintenance when you add services or requirements change

With EasyDocForms, you send us your current paper forms—or just describe your diagnostic approach—and we build the digital version. TCM health history following the 10 Questions framework, modality-specific consent forms, contraindication screening with smart flags. Walk into every appointment prepared, not overwhelmed by intake paperwork.

Frequently Asked Questions

What forms do acupuncture clinics legally need?

At minimum, acupuncture clinics need informed consent for acupuncture treatment, a health history questionnaire, and HIPAA privacy notice. If you offer additional modalities (cupping, moxibustion, e-stim, herbs), each requires specific consent or inclusion in your main consent form. State requirements vary, so check with your licensing board and consider guidance from organizations like the American Acupuncture Council.

How detailed should acupuncture health history forms be?

TCM health history should be more detailed than standard Western intake because diagnosis relies on constitutional patterns, not just symptoms. Include the classical "10 Questions" framework plus sleep, energy, emotional patterns, and lifestyle factors. First appointments typically run 45-75 minutes partly because of this comprehensive assessment—thorough intake forms reduce verbal questioning time.

Do acupuncturists need separate consent for cupping?

Best practice is yes. Cupping carries distinct risks (bruising, burns, blistering) that patients should explicitly acknowledge. Many patients are surprised by cupping marks if not warned. You can include cupping in your main consent form with a specific section, or use a separate modality consent. Either way, the risks must be clearly disclosed and acknowledged.

What are the main contraindications for acupuncture?

Major contraindications include pregnancy (for certain points), pacemakers or implanted devices (for electrical stimulation), bleeding disorders or anticoagulant therapy (requires modification), and active infection with fever. Relative contraindications include severe needle phobia, skin lesions at treatment sites, extreme hunger or fatigue, and intoxication. Your intake should screen for all of these.

How long should acupuncture patient intake take?

Aim for patients to complete intake forms in 10-15 minutes before arrival. This is longer than typical medical intake because TCM diagnosis requires more lifestyle and constitutional information. Digital forms with conditional logic can reduce time for patients without contraindications while ensuring thorough screening for those who need it. The goal is to have diagnostic information ready before you begin tongue and pulse assessment.

Are acupuncture clinics required to be HIPAA compliant?

Yes, if you transmit any health information electronically (which includes email, electronic billing, or digital intake forms). Most modern acupuncture practices meet this threshold. HIPAA compliance requires a Business Associate Agreement (BAA) with any software that handles patient data, encryption for data in transit and at rest, and proper authorization procedures for releasing patient information.

Sources

• American Acupuncture Council - Informed Consent
• Arizona Acupuncture Board - Informed Consent to Treat
• Yin Yang House - The Ten Questions in TCM Diagnosis
• NCCIH - Traditional Chinese Medicine: What You Need to Know
• Effects of Questionnaire-Based Diagnosis on Inter-Rater Reliability (PMC)