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Consultation Form

The community clinic is very busy but also a very calm space. To help with time management, it would be really helpful if you could fill out the online consultation form before you attend your appointment. Please share as much information as possible, as this is essential for diagnosis and treatment, allowing more time to discuss your health. It also means you benefit from a longer treatment. 

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*Acupuncture is a safe method of treatment, but on extremely rare occasions, it may induce minor bleeding, bruising, numbness, or tingling near the needling sites, dizziness, and fainting; these rare side effects do not impose any risks or danger to a patient’s health or life.

Please contact Health Tree Acupuncture acupuncturist John if you have any questions or concerns you may have before your first treatment.

How did you hear about us?
Are you pregnant, could you be pregnant, or are you trying to conceive or having fertility treatment?
Do you take blood thinners or have a bleeding or clotting disorder?
Do you have a pacemaker, ICD or other implanted electrical device?
Have you had lymph nodes removed, or do you have lymphoedema?
Do any of these safety concerns apply to you?
Have you had acupuncture before?
How long have you had this?
Is it getting better, staying the same or getting worse?
Is it affecting any of these?
Do you have, or have you had, any of these?
Energy and general
Head, eyes and ears
Mood and mind
Muscles, joints and bones
Sleep
Skin
Digestion
Urinary
Heart, circulation and breathing
Reproductive and hormonal health
How many hours do you usually sleep?
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