Preparing for your Acupuncture Appointment

Acupuncture is best done when a person is not hungry, and has also not just eaten. If you are coming after work, and very hungry, please have a light snack. Preparing for your acupuncture appointment will help you get the most from your treatment.


Perfume, cologne, and scented hair products and lotions:


Please try not to use anything with fragrances on your treatment day. Definitely do not put on any perfume immediately before your appointment. There are two reasons for this.


First, part of Chinese and Ayurvedic medicine diagnosis is to notice a particular body odor. Don’t worry, its OK. I am a doctor and used to people’s smell.

Second, some of my patients are chemically sensitive, and can have allergic reactions to perfumes and perfumed products, even if they seem “all natural.” Commerical perfumes are actually quite unhealthy, containing petroleum by-products called Pthalates, which disrupt endocrine systems, among other problems.. Perfume companies also include chemical fixatives in their product to make them last longer on your body; the problem is these same fixatives cause the perfumes to remain in a room long after you leave. Thank you so much for understanding.


Time of appointment:


As I see one person at a time, it is not necessary to come early for your appointment. Just being on time is perfect.


Late cancellation:


 Your time has been reserved for you and you alone.  Please give at least 24 hours notice if you need to reschedule so as to avoid charges for an office visit. Thank you for understanding.


Health Questionaire:

There will be a tiny intake form when you come in. I prefer to get all additional information through questioning. But if you would like to answer the following questions and print them out or paste them into an email, that will give us a head start, and get you thinking about the kinds of questions you may be asked.Please answer the following questions briefly. If in doubt give more, rather than less detail. Thank you.



Chief Complaint: List all the symptoms that are of primary concern:


Other Complaints: List symptoms of secondary concern:


What treatments have you had so far, of any type?

Did any of them help at all?

Is there anything that you do at home that makes it better, anything that makes it worse?


Please give a brief history of your major complaints:



Sleep: Do you have any trouble falling or staying asleep?
If so, give details.

Do you feel refreshed in the morning?

Appetite: Strong, Weak, Excessive? Can you eat anything or are you a fussy eater?


Do you feel good after eating? Any indigestion after eating, bloating, belching, heartburn, pain, fatigue?
Any diagnoses such as GERD, Gastritis, Ulcer?


Bowel movements daily? How many times? If not, how often.
Are they well formed, or more like “rocks” or “snakes”
Any constipation or diarrhea with stress?


Have you had any bladder or kidney infections? If so, how many?
Men: Any issues with prostate gland, erectile dysfunction or other urogential problems.


Does your period come at regular intervals?
Is it regularly about the same number of days?
Is the bleeding light, medium, or heavy?
How many days are heavy?
Do you suffer from any symptoms WITH the bleeding, such as cramps, clots, leg pain, constipation, headache.
Do you suffer from any PRE-Menstural symptoms, such as bloating, swollen tender breasts, food cravings, bowel changes, emotional changes such as irritability or crying from things you would not normally cry at? Please be specific.

Libido: Would you describe it as high, average, or below average?

Energy:   Describe your typical energy level –high, low, medium
Any abnormal fatigue

Body Temp: Do you prefer to be cool or warm.

For example,do you like to sleep with a blanket even in warm weather? Are you bundled up when others are not? Do you wear shorts and T shirt when others are warmly dressed? Does hot sun make you feel uncomfortable or headachy?

Climate:  What kind of climate do you prefer–warm, cool, hot, cold, damp, dry
For example, if warm, do you prefer dry heat or moist heat?
What kind of climate do you dislike?

Feelings: Would you describe yourself as by nature fundamentally happy, sad, angry, worried, fearful, easygoing, pensive?

Do any of these occur more predominately or as a recurring theme?

How happy are you with your life right now?
How happy with work, friendships, primary relationship?
What do you do to relax?
Do you meditate or have a spiritual practice of any kind?
What do you do for fun?

Stress: Rate your stress level on a scale of 1 to 10

Exercise: How often and what kind?

Substances: Do you consume coffee, tea, tobacco, alcohol, or any other non-medical drugs? How much and how frequently?

Medical drugs: Please list any pharmaceutical drugs, nutritional supplements, or herbal medicines you currently take.

Diet: What do you eat? Please give a thumbnail sketch of breakfast, lunch, dinner, snacks, beverages, and favored treats.

Are you happy with your diet at this point in time?


That’s It! Thank you!



copyright Eyton J. Shalom, M.S., L.Ac., san diego, ca, 2011 use with permission all rights reserved
Acupuncture, Ayurveda, and Chinese Medicine

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