This questionnaire is designed to help identify the underlying patterns of imbalance affecting your health through the lens of Traditional Chinese Medicine (TCM). Your responses will provide valuable insights into your body’s energy flow, organ function, and overall well-being, allowing us to create a highly personalized approach to your healing.

💡 I understand that this is a long questionnaire, but it is intentionally designed to help you reflect on your symptoms in detail and provide me with as much information as possible. The more thorough your responses, the more accurate and effective your assessment will be.

You may notice that some questions seem repetitive or that their groupings don’t always align with how you think about your symptoms. This is because TCM diagnoses are pattern-based rather than symptom-based, meaning different symptoms may be linked in ways that aren’t immediately obvious.

How to Complete This Form:

✅ Take your time and answer each question as honestly as possible.

✅ If a symptom doesn’t apply to you, simply select the 0 - Never option.

✅ If you're unsure about a symptom, answer based on your general experience rather than a single occurrence.

Thank you for taking your time to complete this form. I look forward to guiding you on your healing journey!