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V-steam Patient Intake bFormb - Karen Craven Acupuncture

V-steam Patient Intake bFormb - Karen Craven Acupuncture 2025

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The document is a V-Steam Patient Intake Form for Karen Craven Acupuncture, requiring patients to provide personal information, medical history, and treatment preferences prior to their V-Steam therapy. It emphasizes confidentiality, outlines potential risks associated with the treatment, and instructs patients on how to submit the form.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date at the top of the form. This helps track your appointment.
Fill in your name and personal details, including date of birth, address, email, and preferred contact method. Ensure all information is accurate for effective communication.
Provide emergency contact information, including the contact's name, phone number, relationship to you, and how you heard about Karen Craven Acupuncture.
In the treatment section, check all conditions that apply to you. This will assist in determining the appropriate herbs for your steam therapy.
List any medications taken within the last two months along with their dosage, frequency, and reason for taking them. This is crucial for your safety during treatment.
Read through the safety information regarding steam therapy carefully. Confirm your understanding by signing at the bottom of the form as either an adult patient or a parent/guardian.

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