Patient Questionnaire
Questionnaires for Customized Acupuncture Treatment
Full Questionnaires (PDF)
It is recommended to complete the full English or Korean questionnaires when visiting the office for personalized acupuncture points and herbal treatments, as advised by Dr. Kim.
Full Consultation for Acupuncture & Herbs Intake Form – Instructions
Please review the following symptoms and consider how you have felt over the past 2–3 months.
Mark “VV” if the symptom has been Severe (noticeable and uncomfortable).
Mark “V” if the symptom has been Moderate / mild (noticeable but not uncomfortable).
Leave the space blank if you have not experienced the symptom.
If any symptom feels important or if you would like to provide more details, please add a comment.
Your responses will help guide your acupuncture treatment, and all marked items will be reviewed carefully during your consultation.