Acupuncture Intake Form

The Acupuncture Intake Form helps you gather patient details, symptoms, and lifestyle information before treatment begins. It gives you a complete view of the patient’s health and helps build a personalized care plan from the start.

It reduces paperwork at check-in and improves patient experience.

About this template

This form collects medical history, health concerns, emotional well-being, and lifestyle habits. It’s ideal for acupuncture clinics, integrative health centers, and wellness practitioners.

Why Use This Acupuncture Intake Form?

Your first session should focus on healing, not handwriting. This form lets patients submit their health information in advance, so you spend more time on care and less on admin work.
You get accurate, structured data that helps guide diagnosis and treatment.
Perfect for new patients, follow-ups, or ongoing care reviews.

Smart Features That Make Your Workflow Smoother

  • Let patients sign digital consent forms securely → Enable electronic signature

  • Allow uploads of lab reports, test results, or past treatments → Enable file uploads

  • Use conditional logic to uncover stress, sleep, or digestion issues

  • Export intake forms for integration with EMR systems

  • Customize form branding to match your clinic’s look

How to Use This Form

  1. Click Use Template

  2. Add your clinic name, consent text, and form instructions

  3. Customize questions for symptoms, habits, and treatment goals

  4. Share the form before the appointment by email or website

  5. Review all submissions in your dashboard to prepare in advance

Use this form to get a deeper understanding of your patients and deliver more effective acupuncture sessions from day one.

Looking for more templates?

Simplify your form creation process with our range of professionally designed form templates. Choose from a variety of styles and designs, including contact forms, surveys, job applications, and more - all available now for free!

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