Acupuncture Intake Form

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An acupuncture intake form is a great way to improve your patient intake process and effectively obtain informed consent right from the first consultation (and even before your patient arrives at your clinic). This form helps you fully understand your client's health situation, needs and expectations in a professional and user-friendly way.

You can create your own intake form, drafting a comprehensive yet simple document that collects all the necessary information for your practice. Need help? Read on to find out the main aspects you should cover.

Note: Take your acupuncture business to the next level with Bonsai's full range of administrative tools. We help you streamline your processes from client onboarding, to invoicing, payments, taxes and much more! Try a 7-day free trial here.

What Information Should Be Included in Acupuncture Intake Forms

No two intake forms are the same, and the specific questions you ask will vary depending on your niche, clients and business goals. The following aspects will provide a basic guideline to follow when creating your own document, but feel free to incorporate topics that concern your specific practice.

General Information

Begin your intake form by gathering all basic client and contact information. This includes their full name, phone number, email address, billing/physical address and any other personal information you find necessary for your practice (employment, marital status, children, etc.) Ask the client to provide emergency contact information including full name and relationship.

Health History

It's important that you learn about the client's past and current health conditions as they may require additional health or attention. Cover any current symptoms, adverse reactions to medications, serious diseases, hospitalizations, recent surgeries, family physical or mental illnesses, as well as current prescription and non-prescription medications.

Lifestyle & Goals

The client's lifestyle and habits will give you an insight into any underlying reasons for their current symptoms and help you understand their health goals. Inquire about their daily diet, sleep schedule, personal relationships, sugar intake, hobbies and work-related issues. Additionally, ask about any recreational drug use (drinking, smoking, etc...), and exercise routine (if any).

Don't forget to include a set of questions to ask why they are seeking your services and what they expect to get out of the acupuncture therapy.

Informed Consent

Last but not least, it's important that your clients thoroughly understand the nature of the treatment, risks and side effects, the expected benefits, consequences of not having a treatment, and their full right to stop, modify or ask questions about the treatment at any time. This is referred to as 'Informed Consent' and can be included as a clause at the end of your client intake form.

Create the Perfect Client Intake Form With Bonsai

If you want to be a successful acupuncturist, you have to give your patients the best attention and care. Acupuncture has been shown to be effective for a wide variety of conditions, but in order to maximize its efficacy, it is important to understand the whole person - not just the presenting condition. That is why taking a thorough history from each of your patients is so important.

By taking the time to really get to know your patients through this acupuncture intake form, you can tailor each treatment specifically to their needs and help them achieve optimal health and well-being. This acupuncture intake form is designed to streamline the process for both acupuncturists and patients. With clear and concise questions, it allows you to quickly gather the information you need to provide the best possible care.

If you're ready to create your own acupuncture intake form, make it simple with Bonsai's client form builder! Our forms are fully customizable so you can add as many questions as you need, select your preferred answer format and rearrange fields to your liking. You can also incorporate your business branding elements to make it unique and easily recognizable for your clients.

Once your intake form is ready, you can share it directly with your clients via email, URL link, or have it embedded into your business website. Sign up for a 7-day free trial today to save time and create professional documents without compromising quality.

Frequently Asked Questions
Questions about this template.

Try Bonsai to easily design and format intake forms to onboard new acupuncture clients. Our designer is free to use and you'll be able to create intake forms instantly.

What is an intake checklist?

An intake checklist gathers all the data that a department or organization needs to appropriately evaluate and route a person or request through a business process. Put simply, it's a questionnaire to gather more background information on your client.

How do you make an intake sheet?

Sign up with Bonsai and use our form builder at no cost. Ask questions using our guide to cover all of the medical history, client background and anything to help your onboarding process.

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