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Health History and Questionnaire

Dear Client,

Chinese medical diagnoses are made by accessing each part of the body and interpreting how it functions as a whole unit. Much of my understanding comes from questions I ask about your health and health history. It is very important to completely fill out the health history and questionnaire, located at the bottom of this page. If for some reason you are unable to print the forms, please call the office and I will e-mail or fax them to you.

Completion of paper work has not been built into your scheduled appointment. You have two options to choose from for filling out paperwork, print a hard copy and bring with you or submit via the internet using secure form.
Should you forget to complete the paper work before coming to the office, the treatment component of your visit may have to be rescheduled to another day and time.

Thanks in advance for your understanding and cooperation.


Lynn Borzillo, D.A., Dipl. Ac.

Securely submit health history online
Print a hard copy