By Karen E Johnson, RN, MPH, Naturopath
|
|
- Donald Houston
- 5 years ago
- Views:
Transcription
1 By Karen E Johnson, RN, MPH, Naturopath
2 DISCLAIMER AcuColors does not provide medical advice, diagnosis or treatment. Content from AcuColors is not intended to be used for medical diagnosis or treatment. The information provided in this book is intended for general consumer understanding and self-improvement only. The information provided is not intended to be a substitute for professional medical advice. As health and nutrition research continuously evolves, we do not guarantee the accuracy, completeness, or timeliness of any information presented in this book.
3 AcuColors Objectives: 1. Discover an alternative way of healing with Acucolors. 2. Discover basic TCM Diagnostic methods to pinpoint meridian imbalances. 3. Learn how to apply colored light on the acupoints to heal the Body- Soul-Spirit levels. 4. Work through at least one health issue using the 3 Acucolors treatment techniques for whole holistic healing.
4 WHAT IS ACUCOLORS? AcuColors is a healing therapy that incorporates many of TCM concepts, such as Acupuncture & Iridology, to address the whole person in Body, Soul and Spirit. Colored light heals, restores function deep into the cells of the body, & releases hidden negative emotions.
5 ACUCOLORS works with: the WHOLE Person in Body-Soul-Spirit Physical Body: the Body is the physical vector which carries the Soul and the Spirit in this world. It needs nutrition and exercise to remain healthy and functional. It is subject to harm from accident or illness. Emotional Soul: The Soul is the psychological reflector of emotion. It can be portrayed as an aura around the outside of the body. Mind Spirit: The Spirit is our rational, intellectual director, or the mind. It is our beliefs and our standards by which we interpret situations and our connection with higher sources of information, or God.
6 The Meridians The Spirit, the information director, is located at the center of the meridian network of the body. Meridians are energy pathways that carry information from the Spirit to the Soul and to the Body. This communication is essential to good health. Any miscommunication leads to illness and is usually caused by conflict between the soul (emotion) & spirit (thought) and hidden negative emotions which cause energy flow blockages in the meridians.
7 FIVE PAIRED MERIDIAN PATHWAYS SPIRITUAL MERIDIAN NETWORK Liver/Gall Bladder Lv/GB Stomach/Spleen St/Sp Kidney/Bladder Ki/Bl MAIN SOUL EMOTION Anger Worry Fear PHYSICAL DISEASE TENDENCIES OF THE BODY Allergies, Anxiety, Aphasia, Chronic Fatigue, Convulsions, Dizziness, Eye & Ear issues, Fever, Gallstones, Hip pain, Hypertension, Leg arthritis, Meningitis, Migraines, Mood disorders, Muscle Atrophy, Nausea, Numbness, PMS, Rib pain, Sciatica, Shoulder pain, Stroke, Tinnitus, Weakness Anemia, Anorexia, Diabetes, Food Poisoning, GERD, Glaucoma, Hives, IBS. Dyspepsia, Indigestion, Joint & Bone pain, Knee pain, Menstrual cramps, Muscle Spasms, Nausea, PMS, Smell or Taste issues, Sty, Toothache, Ulcers, Urinary Tract infections Anorexia, Arthritis, Bladder infections, Edema, Epilepsy, Fatigue, Foot pain, Hearing & Speech issues. Hiccups, IBS, Impotence, Joint pain, Knee, Leg, Low Back Pain, Low Libido, Muscle spasms, Osteoporosis, Premature Graying, Prostatitis, Rapid Pulse, Reproductive issues. Hereditary weaknesses, Respiratory ailments, Sciatica, Sexual dysfunction, Systemic diseases, Tinnitus. Urinary disorders, Vertigo Lung/Large Intestine Lu/LI Heart/Small Intestine Ht/SI Sadness Love Acne, Allergies. Asthma. Bell s Palsy, Bronchitis, Cold symptoms, Congestion, Cough, Cough. IBS, Crohn s, Depression, Diarrhea, Dry Skin, Eczema, Elbow pain, Fatigue, Flu, Immune deficiencies, Itching, Learning disorders, Nasal Obstruction, Sinus infection, Sneezing, Sore throat, Stress, Toothache, Ulcerative Colitis, Upper Back pain, Anemia, Blood Pressure/Heart rate & rhythm, Celiac disease, Chronic Cough; Shoulder & Neck pain. Sore Throat, Fatigue, Insomnia, Mouth sores, Mumps, Neuralgia, Nightmares. Fever, Numbness in fingers, Poor Circulation in arms & legs, Poor Memory, Sweating, Swollen Glands, TMJ syndrome.
8 What happens if we repress a negative emotion? The repressed emotion blocks energy flow through the meridian channels of the body causing physical damage at the cellular level of the body. The negative emotion is trapped like being inside a fog. ACUCOLORS releases trapped emotions and opens up the blocked meridians allowing positive light energy to heal the cells of the body.
9 Part I Diagnostic Techniques Areas of Inspection: Fingertips Nailbeds Tongue Ears Eyes Face Meridian Measurement
10 Fingertip Testing 1. Press firmly in the middle of the last digit of each finger, just under the round fingertip pad. Sharp pain that makes you want to yell OUCH! is a positive response. 2. Follow the testing in this order: Left Hand (LH) ; Right Hand (RH) Check for Imbalance side to side. If sore fingers are not the same on LH or RH, then there is a Laterality imbalance and need Corpus Callosum treatment. 4. When there is a T o F difference top to bottom, such as hot hands and cold feet, then there is a Polarity issue and a Vertical treatment is needed. BODY SYSTEM SENSITIVE FINGER(S) REGULATING FUNCTION FINGER CHART BY BODY SYSTEM Lymphatic Lv GB RH & LH Thumb(1 st ) Immune support & eliminate toxins thru lymphatic system. Nervous Sp St RH & LH Index (2 nd ) Transfer info between nerves & muscles for movement Musc Skel Ki Bl RH & LH Middle (3 rd ) Transfer info between nerves & muscles for movement Endocrine Lu LI RH & LH Ring (4 th ) Gland & Hormone Regulation Blood Ht SI RH & LH Little (5 th ) Circulation of oxygenated blood to the vital cells & organs PROBLEM Congestion Degeneration Degeneration Dysregulation Stagnation
11 LATERALITY & POLARITY Horizontal (Side to Side) Treatment LOCATION: Corpus Callosum point, mid nose & upper lip. 20 sec on point INDICATION: Balances Side to Side. COLOR: Yellow Vertical (Top to Bottom) Treatment LOCATION: Hypothalamus points in line with the pupils midway between hairline & eyebrows. Also GV2 at top of buttocks fold. 20 sec each point INDICATION: Balances Top to Bottom. COLOR: L=Orange; R=Blue: GV2=Orange
12 NAILBED INSPECTION COLOR Yellow shows LvGB from impaired Lymph Drainage. Yellow, Green or Black can also mean a bacterial infection. Yellow with Pink base = Diabetes (SpSt) Blue indicates a weak heart. Blue-green shows a fungal infection. (HtSI) Red excess RBCs. If in nailbed, it confirms a heart problem. (HtSI) White could mean liver disease. ½ White ½ Pink = Kidney disease. Pale nailbed = Anemia (KiBl) ABNORMALITIES a. Longitudinal Ridges = FA deficiency, poor absorption of food, aging, kidney disorder, infection, arthritis (KiBl) b. Clubbing = depletion of O2 in blood, COPD, Celiac disease, IBS (LuLI) c. White spots = weak immune system d. Onychomycosis = systemic fungal e. Spoon nails = blood iron disorders
13 TONGUE INSPECTION COLOR NORMAL: pink, flexible with a think clear coat & moisture VIOLET: (LvGB:Anger) venous stagnation, slow blood circulation, poor oxygenation RED: (KiBl:Fear) fever, vitamin deficiency, dehydration; the more red the more inflammation or acidity. This causes Stomach and Kidney damage. PALE (LuLI:Sadness) = Blood deficiency, Low BP, hypothyroid, metabolic deficiency leading to cold hands & feet, dehydration. REGION Dehydration GERD
14 EARS For organ function & buried emotions, probe the organ points for pain. If painful, use the complementary color to release the buried emotion and heal the organ. ORGAN Bladder (Bl) Kidney (Ki) Gallbladder (GB) Liver (Lv) Large Intestine (LgI) Lung (Lu) Spleen (Sp) Stomach (St) Heart (Ht) Small Intestine (SmI) COLOR Green Red Violet Yellow Orange Blue Orange Blue Pink Turquoise Heart prob
15 EYES Hematogenic (Brown eye)-- Glandular, Lymphatic congestion (LvGB) 1.Chronic Stress Rings -fibers buckle 2.Radii Solaris -toxic waste dump 3.Cholesterol Ring= too much cholesterol in blood. Lymphatic (Blue eye)-- Allergies, Overactive immune system; Colds, Sinus, Respiratory infections, GI disorders; Arthritis, Adrenal, Kidney & Thyroid problems (LuLI) 1.Neurogenic fibers- CNS weak 2.Lymphatic Congestion mucous 3.Hematochromia-- LvGB Pancreas issues 4.Scurf Rim-dark ring around outside of iris=skin circulation issues. Use dry skin brushing to increase circulation. Biliary ( Green Mixed Blue with Brown eye)-- GI, GB issues; Pancreatic Blood Sugar issues; Diarrhea, Constipation, Flatulence (SpSt) 1.Polyglandular endocrine 2.Lymphatic Rosary-congestion 3.Uric acid-=gout 4.Ballooning in Nerve Wreath- excess gas, hiatal hernia
16 IRIS MAPPING
17 I RIDOLOGY P HOTOS R
18 Look for unusual: Eye Color Collarette size, shape, color Spots and where they fall drug toxicity? Scurf Rims Cholesterol Ring Radii Solaris Open Lesions White part of eye-dbl troicha sx of Ca Congestions (white)
19 Notice Size, shape of pupil High inflammatory areas in abdomen Amount of mucous
20 Green Eyes? High catarrh Double Troicha in sclera Irregular collarette
21 FACE INSPECTION OBSERVE FOR CHANGES IN: Color darkened areas, pigment changes Shape --asymmetry Skin wrinkles, swelling Meridian Zones any changes over meridian areas 1. CHEEKBONE Swollen Blue-White color=diaphragm & CNS). 2. EYE -inner corners Adenoids swollen, brown=chronic constipation, breast issues. Ki 3. NOSE - Red or swellings =Lu ; Red Nose tip=thyroid 4. UPPER LIP -(heart fold) =Lighter & retractions are cardiac signs. 5. R LOWER LIP - swellings =Lv. 6. CENTER CHIN = pancreas. Pc includes genitals 7. L LOWER LIP =Sp. 8. LIPS = Narrow tight lips =mesenchymal issues. SI LI 9. CENTER UPPER LIP Acid folds of gas, bloating, metabolism- St 10. CENTER BROW Conflict Acid folds from stress & conflict. LvGB
22 MERIDIAN MEASUREMENT
23 Part II TREATMENTS Traditional Chinese Medicine (TCM) does not treat individual health conditions since they are only symptoms of greater energy imbalances in the body. 1. The Regulatory Treatments resynchronize the overall 5 paired meridian systems. (Section 1) 2. Treating specific health issues (A-Z) releases negative emotions in targeted organs. (Section 2) 3. Rebalancing the meridian systems cures the disease. (Section 3)
24 SECTION 3: MERIDIAN BALANCING REBALANCING THE MERIDIAN SYSTEMS CURES THE DISEASE. Meridians are energy pathways that link the outside physical body to the inside spirit body. The meridians are closely linked to the nervous system and the nerve pathways that feed every organ and part of the body, yet they also control the flow of chi throughout the whole body-soul-spirit. When a meridian is out of balance, symptoms will show up. From 5 Paired Meridian Pathway table, MigHA are from LvGB imbalance. HOW TO BRING MERIDIANS INTO BALANCE: Meridian Tracing: A good way to balance the meridians is tracing the meridian pathways. Trace the pathway either by using a bingo magnet pointing the negative pole toward the skin to sedate, or by using the cool color. Each meridian has 2 sides--right and Left. Stroke both sides of each meridian in the cool color blue to sedate over-activity such as diarrhea, starting at RED and ending at GREEN. Stimulate an underactive bowel, or constipation, using the warm color orange tracing the Large Intestine meridian, beginning at GREEN and ending at RED. Sedate Strong Points-- Sedate strong points with a cool color or using magnet with (-) end toward skin. Stimulate Weak Points Tonify weak points with a warm color or using magnet with (+) end toward skin. Side to Side Balancing: this is done using complementary colors. For example, the Liver meridian has been detoxified. Now to balance the meridians, Violet is used to trace the Left side of the Liver meridian and Yellow on the Right.
25 LIVER-GALL BLADDER Anger is a powerful emotion that may produce migraine HAs, eye problems, myopathy or tendinitis. Meridian Underactive Warm Color Overactive Cool Color Liver Yellow Violet Gall Bladder Yellow Violet
26 STOMACH-SPLEEN Ever heard of the Worry-Wart that ends up with stomach ulcers? Meridian Underactive Warm Color Overactive Cool Color Stomach Orange Blue Spleen Orange Blue
27 KIDNEY-BLADDER Fear and anxiety are common in young children and can even be transferred from the parents to the unborn child while in the womb. Meridian Underactive Warm Color Overactive Cool Color Kidney Red Green Bladder Red Green An additional step, stroking 5 times on the Kidney/Bladder lines on the feet can clear unwanted antepartum emotions. 1. Kidney Line 5x 3 rd toe to heel on bottom of L&R foot Orange 2. Bladder Line 5x 5 th toe bunion to heel on side of L&R foot Yellow
28 LUNG-LARGE INTESTINE Grief or sorrow will settle in the lungs. Meridian Underactive Warm Color Lung Orange Blue Large Intestine Orange Overactive Cool Color Blue
29 HEART-SMALL INTESTINE The Heart should be full of Unconditional Love. This meridian should never be out of balance. If it is, then the others are as well, since the other meridians protect the Ht/SI at all costs. Meridian Underactive Warm Color Overactive Cool Color Heart Rose Turquoise Small Rose Turquoise Intestine
30 When there is light in the soul there will be beauty in the person. When there is beauty in the person, there will be harmony in the house. When there is harmony in the house, there will be order in the nation. When there is order in the nation, there will be peace in the world. --Old Chinese Proverb I-Ching Hexagram
31 For Further Information: The website has a copy of this presentation and a link to my Amazon e-books.
Introduction to. AcuColors. Karen Johnson, RN, MPH, Naturopath, CCP
Introduction to AcuColors Karen Johnson, RN, MPH, Naturopath, CCP DISCLAIMER AcuColors does not provide medical advice, diagnosis or treatment. Content from AcuColors is not intended to be used for medical
More informationIntroduction THE PHYSICAL BODY
Introduction THE PHYSICAL BODY Traditional Chinese Medicine (TCM) teaches us that the whole person includes 3 entities the Body, the Soul and the Spirit. When disease strikes, it affects all 3, not just
More informationOn a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the areas below:
Healthcare History djp Pure-Health wellness centre www.pure-health.com Wellness Profile General Health On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the
More informationWhat do you believe is causing your most important health concern?
Intake form Name Today s Date Date of Birth Address City Phone Postal Code Email Primary Health Care Provider Emergency Contact Phone Note: By providing your email address you are giving us consent to
More informationAN INTRODUCTION TO. KAREN E JOHNSON, RN, MPH, CCP, NATUROPATH
AN INTRODUCTION TO AcuColors KAREN E JOHNSON, RN, MPH, CCP, NATUROPATH WWW.ACUCOLORS.COM karen@acucolors.com Text copyright @ 2016 Karen E Johnson All rights reserved. Without limiting the rights under
More informationEmotional Relationships Social Life Sexually Recreation
Name Date Address City State Zip Married Single Partner Divorced Widowed Date of Birth SS# Email Work Phone Home Phone Cell Phone Occupation Referred by Emergency Contact Family Physician Contact May we
More informationEssential Wellness Of Illinois, LLC Health History Questionnaire Christine A. Renz L.Ac., Dipl OM, MSTOM
Name Date Address City State Zip Home Phone Cell Fax Email Emergency Contact Emergency Number Date of Birth Age Sex Height Weight Lbs Marital Status Occupation Who referred you to this office? Name of
More informationShiatsu Intake Form PURCHASED PRODUCT/SERVICE. Date of Birth Age Height Weight. Home Address City State ZIP
Shiatsu Intake Form DATE PURCHASED PRODUCT/SERVICE FIRST NAME LAST NAME Date of Birth Age Height Weight Home Address City State ZIP Home Phone Cell Phone Email Name of Emergency Contact Would you like
More informationJohanna M. Hoeller, DC PS
ENTRANCE FORM Birth date: Height: Weight: Emergency Contact: Emergency Contact Phone: ( ) Spouse/Partner or Parent s name: Children s names: Occupation (Your): Employer: Address: City/State/Zip: Phone:
More informationMedical History Form
General: Medical History Form 1. Chief Complaint: What are the main health concerns you wish to address? 2. Current and Past Treatment: Have you received treatment for these problems? Yes No, if yes, which:
More informationInner Balance Acupuncture
Patient Information Inner Balance Acupuncture 274 Southland Drive, Suite 101, Lexington, KY 40503 859-595-2164 www.acupunctureky.com Name: Today s date: Age: Male Female Marital status: Date of Birth:
More informationAcupuncture Health History Page 1 of 5
General Contact Information Acupuncture Health History Page 1 of 5 Name: Date of Birth: Address: City: Postal Code: Contact Numbers#: Home #: Email: (By checking you give David E. Chung Permission to email
More informationSymptom Review (page 1) Name Date
v2.4, 2/13 JonathanTreasure.com Botanical Medicine & Cancer Herb Drug Interactions Herbalism 3.0 Symptom Review (page 1) Name Date INSTRUCTIONS Please read each section below carefully and, after each
More informationPatient Information. Marital Status (Single, Married, Life Partner, Divorced, Widowed) CHIEF COMPLAINT
Patient Information Name Date Home Address City State Zip Phone E-mail Address Cell Phone: Business Address City State Zip Phone Occupation Place of Birth Date of Birth Age Height Weight Soc. Sec. # Sex
More informationCaspian Acupuncture -- Health History Form Anita Tayyebi EAMP, LAc. 652 SW 150 th St Burien WA 98166
Frist Name Last: Date Phone (H) (C) (W) E-mail Address City State Zip Age DOB Place of Birth _ Marital/Partnership Status Preferred Gender Pronoun _ Profession Family Physician Telephone # Referred By
More informationThe Rehabilitation Institute Cancer Rehabilitation
DO NOT DRILL The Rehabilitation Institute Cancer Rehabilitation STAR Patient Intake Form Your Name: Date: Your date of birth: Age: Who referred you (if a healthcare provider, please provide address)? Doctors
More informationSound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA
Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA 98136 206.200.3595 Today s date Name Legal name (if different) Phone (primary) (secondary) Address City State Zip Email
More informationQuestionnaire for Lipedema Patients
Questionnaire for Lipedema Patients Name Date of diagnosis Date Name of physician making diagnosis Do you also have lymphedema? What areas of the body are affected? Outside of thighs Inner thighs Knees
More informationFacial Assessment. Color. Lines in the Skin.
Facial Assessment Color. Red. Heat, inflammation, upward movement. White. Closure of capillaries, cold, shock, downward/inward movement. Blue. Lack of oxygen. Purple. Stagnation, bruises. Yellow. Liver,
More informationNew Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care
Page 1 of 7 Patient Demographics First Name* Last Name* Date Of Birth* Home Phone* Mobile Phone Phone Gender* Email Preferred Communication Street Address 1* Street Addresss 2 Zip* City* State* Emergency
More informationOriental Medicine Questionnaire
Oriental Medicine Questionnaire Date: Name: DOB Sex: M F SS# Address: City State Zip Cell Phone: Home Phone: Business Phone Occupation: Height: Weight: Who referred you to this office? 1.What brought you
More informationCONTENTS. Preface. Introduction. The Gem Sticks. Working with the Hand Rod or Pendulum. Types of Therapy. Gemstone Reflexology By Nora Kircher
Gemstone Reflexology By Nora Kircher CONTENTS Preface Introduction The Gem Sticks Amethyst Aventurine Fluorite Heliotrope Rock Crystal Rose Quartz Rutile Quartz Sodalite Working with the Hand Rod or Pendulum
More informationNatalie Kilheeney L.Ac., Dipl. OM Licensed Acupuncturist & Herbalist
*All information is important to your intake and valuable to your personal treatment plan. Please answer as thorough as possible. Patient Information: Name: Date: / / (First Middle Last) Address: City:
More information06/09/2005 Medical history and intake form
Medical history and intake form Please complete this form as accurately as possible - it helps to provide you with the best possible treatment. Address including postcode Contact numbers Home/work/mobile
More informationThe Rehabilitation Institute Cancer Rehabilitation
DO NOT DRILL The Rehabilitation Institute Cancer Rehabilitation Patient Intake Form Your Name: Date: Your date of birth: Age: Who referred you (if a healthcare provider, please provide address)? Doctors
More informationPATIENT INFORMATION FORM (WOMEN ONLY)
PATIENT INFORMATION FORM (WOMEN ONLY) Name: Age: Sex: Birthdate: / / SS # A. Describe briefly your present symptom(s) or the reason(s) for seeing the doctor today: B. Name all illnesses or conditions for
More informationThe TMJ Therapy Effects of Joint Manipulation
The overall postural structure associated with TMJ disorders is part of the The TMJ Therapy concern. Chiropractic manipulation has helped realign the joints in your TMJ, neck, and low back and along with
More informationTongue Evaluation. Body Color. Including colors at different locations. Indications. Body temperature regulation.
Tongue Evaluation Christopher Rodgers, Student Body. Refers to the overall appearance including muscles, arteries, and veins. Associations. Conditions of the cardiovascular, nervous, reproductive, urinary
More informationBROADWAY SPORTS & INTERNAL MEDICINE, P.S TH AVE NE SUITE 202 BELLEVUE, WA P: F:
BROADWAY SPORTS & INTERNAL MEDICINE, P.S. 1600 116 TH AVE NE SUITE 202 BELLEVUE, WA 98004 P: 206 215-2288 F:206 215-2289 MEDICAL HISTORY QUESTIONNAIRE Date Name Date of Birth HT WT Current Medical Complaints
More informationPatient Intake Form for Allegany Ear, Nose, & Throat
Patient Intake Form for Allegany Ear, se, & Throat Patient Name: What brings you to the office today? Who is your primary care doctor? Please list your current medications: Are you allergic to any medications?
More informationPATIENT HEALTH QUESTIONNAIRE Radiation Oncology
REVIEWED DATE / INITIALS Safety: Yes No Are you at risk for falls? Do you have a Pacemaker? Females; Is there a possibility you may be pregnant? Allergies: Yes No If YES, please list medication allergies:
More informationPATIENT MEDICAL HISTORY INTAKE FORM
Northgate Professional Center 1985 Main Street, Suite 209 Springfield, Massachusetts 01103 Tel; 413-455-1081 Fax; 413-391-7489 www.marimedconsults.com PATIENT MEDICAL HISTORY INTAKE FORM Patient Information:
More informationBACK TO BASICS HEALTH & NUTRITION COMPREHENSIVE HEALTH HISTORY
BACK TO BASICS HEALTH & NUTRITION COMPREHENSIVE HEALTH HISTORY Thank you for choosing Back To Basics Health & Nutrition to assist you with your natural health care. The ability to draw effective conclusions
More informationPlease answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY
PATIENT QUESTIONNAIRE / ASSESSMENT Endocrinology Form Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY Date Phone (H) (W) (C) Age Male Female Marital
More informationBalanced Healing Acupuncture, LLC
Balanced Healing Acupuncture, LLC Intake Form NAME: Last First: GENDER: Date of Birth / / Age Email Address Address City State Zip Code Preferred Phone Number Cell Home Work Preferred Method of Communication:
More informationPatient History Form
Patient History Form Advanced Directive Care Plan? Yes No Name: Birth date: / / Address: Age: Sex: F M STREET DAY YEAR Telephone: Home ( ) CITY STATE DAY YEAR MARITAL STATUS: Divorced Separated Alive/Age
More informationNEW PATIENT HEALTH HISTORY
NEW PATIENT HEALTH HISTORY Debra Joan Wood, Lic Ac, MAcOM Acupuncture and Herbs Please help me provide you with a complete evaluation by taking the time to fill out this questionnaire carefully. If there
More informationMERIDIAN SYMPTOMOLOGY
MERIDIAN SYMPTOMOLOGY According to Fukushima Kodo and Shudo Denmai a Summation by Jake Paul Fratkin, OMD Originally published in North American Journal of Oriental Medicine, Vol. 5, No. 12, March, 1998.
More informationAmerican Health Acupuncture LLC Healing the Body, Mind, & Spirit 7130 N Omar Dr Tucson AZ (520)
American Health Acupuncture LLC Healing the Body, Mind, & Spirit 7130 N Omar Dr Tucson AZ 85741 (520) 544-6603 Notes for new Patients: Your first session * Can you imagine not having to wait at a doctor's
More informationSymptom Questionnaire
Symptom Questionnaire The following questionnaire is a general assessment of your health developed by Dr Royal Lee D.D.S. Each grouping represents a particular area of your body that may be causing you
More informationMedical History Form
Medical History Form NAME DOB / / TODAY S DATE MEDICAL HISTORY What medical Conditions do you have? Select all that apply, or write in if not listed: Diabetes High Blood Pressure Thyroid Disorder Heart
More informationMetabolic Assessment Form
Metabolic Assessment Form Approach Wellness and Aesthetics 200 Forsythe Street Fayetteville, NC 28303 Office: (910) 322-7368 Fax: (910) 483-5796 www.tawellness.net Name: Age: Sex: Date: Part 1: Please
More informationPATIENT HEALTH QUESTIONNAIRE Radiation Oncology
REVIEWED DATE / INITIALS Safety: Are you at risk for falls? Do you have a Pacemaker? Females; Is there a possibility you may be pregnant? Allergies: If YES, please list medication allergies: Do you have
More information205 W Giaconda Way, Suite 135 Tucson, AZ, (520) Name: Birth date: Age: Today s Date:
205 W Giaconda Way, Suite 135 Tucson, AZ, 85704 (520) 219-2400 www.forever-able.com info@forever-able.com Name: Birth date: Age: Today s Date: Address: Email: Home phone: Mobile phone: May we add you to
More informationNew Patient Medical History Intake Form
New Patient Medical History Intake Form Name: Todays Date: / / Date of Birth: / / Age: Gender: M / F Marital Status: S M D W Address: City: State: Zip Code Primary Ph.# (cell, hm, wk) Email Address 2nd
More informationNutrition Consultation Intake Form Please write or print clearly
Artemis in the City, LLC Danielle Heard, MS, MS, HHC Clinical & Functional Nutritionist ph: 866-330-5421 fx: 212-535-3234 www.artemisinthecity.com Nutrition Consultation Intake Form Please write or print
More informationDr. Andrea Gri B.Kin, ND Doctor of Naturopathic Medicine Phone: Fax: Peter Robertson Blvd, Brampton ON L6R 1T4
Dr. Andrea Gri B.Kin, ND Doctor of Naturopathic Medicine Phone: 905-793- 8868 Fax: 905-793- 8957 630 Peter Robertson Blvd, Brampton ON L6R 1T4 ADULT INTAKE FORM Name: (Last) (First) (Preferred Name) Address:
More informationWELLNESS HISTORY. Patient s Name: Date
u:\share\sr dr\wellness history1 08-08-13 1 WELLNESS HISTORY Patient s Name: Date 1) Have you ever been to Acupuncturist? Yes No If Yes: Currently In the past, When: Did it help? What treatment did you
More informationLaser Vein Center Thomas Wright MD Page 1 of 4
Demographics Laser Vein Center Thomas Wright MD Page 1 of 4 Patient Name: Address: City, St, Zip Primary Phone: Alternate: DOB: Social Security #: Insurance Information Primary Insurance ID# Group# Subscriber
More informationMEDICAL QUESTIONNAIRE (female)
MEDICAL QUESTIONNAIRE (female) Slievemore Clinic, Old Dublin Road, Stillorgan, Co. Dublin. Tel 01-2000501 The appointment comprises of a discussion about this questionnaire and a subsequent medical examination.
More informationACUPUNCTURE INTAKE FORM
, ND ACUPUNCTURE INTAKE FORM Thank you for taking the time to complete the following new patient forms. Given this form is extensive, it plays an integral role in achieving our mutual goal of your optimal
More informationBridges Family Wellness PC. New Patient Intake. Bridges Family Wellness Intake Form SE Lake Rd, Suite 102 Milwaukie, OR
New Patient Intake Bridges Family Wellness Intake Form Full Name: * What is your birthdate? MM/DD/YYYY * What is your gender identity? * Home address: * Cell Phone * Other Phone number(s): Emergency Contact
More informationTHE MANY SYMPTOMS ROOTED IN HORMONE IMBALANCES
abdominal pain acne aging process accelerated allergies, including asthma, hives, rashes, sinus congestion anemia (blood hemoglobin low) anorexia anovulatory (no ovulation) anxiety anxious depression appetite
More informationMEDICAL QUESTIONNAIRE (male)
MEDICAL QUESTIONNAIRE (male) Slievemore Clinic, Old Dublin Road, Stillorgan, Co. Dublin. Tel 01-2000501/502 Fax: 01 2780248 The appointment comprises of a discussion about this questionnaire and a subsequent
More informationMEDICAL INFORMATION. SECTION 1: Pharmacy Information. Pharmacy Name and Address: Pharmacy Phone Number: SECTION 2: Social History
MEDICAL INFORMATION TODAY S DATE: SOCIAL SECURITY NUMBER: PATIENT NAME: BIRTHDAY: HEIGHT: WEIGHT: AGE: WHO REFERRED YOU? RACE: PRIMARY CARE PHYSICIAN: SEX: DOCTOR S ADDRESS: SECTION 1: Pharmacy Information
More informationEastern Body Therapy
2310 Eastern Body Therapy 6th Avenue San Diego, CA 92101 (619)772-4002 Personal Information Name Date of injury/illness Address: Apt. City State Zip Home phone: ( ) Work Phone: ( ) E-mail: Social Security
More informationPlease fill out the following form in as much detail as possible. Please Print. Name. Address. City State Zip. Home Phone Office Phone.
CASE NO. Please fill out the following form in as much detail as possible. Please Print Date Name Address City State Zip Home Phone Office Phone E-mail Address Age Date of Birth Occupation Sex (M) (F)
More informationLuo Vessels, Cutaneous and Muscle Regions
Chapter 3 Luo Vessels, Cutaneous and Muscle Regions 1 Characteristics of Luo Vessels Connect external/internal pairs Distribute qi throughout the body Harmonize circulation 2 In all, there are fifteen
More informationAmarillo Surgical Group Doctor: Date:
Office Visit Information (General Surgery) Amarillo Surgical Group Doctor: Date: Patient s Information Name: Last First Middle Social Security #: Date of Birth: Age Gender: [ Male / Female ] Marital Status:
More informationPatient Information. Vibrant Health Acupuncture & Wellness Center, LLC 260 Gateway Drive, Suite 7B Bel Air, Maryland
Patient Information Vibrant Health Acupuncture & Wellness Center, LLC 260 Gateway Drive, Suite 7B Bel Air, Maryland 21014 410-913-8322 Patient Name: Date of Birth: Age: Male: Female: Single: Married: Separated:
More informationBodily Conditions Rooted in Hormone Imbalance
Check this list for all conditions that apply to you. The total possible score is 209. Count the number of symptoms you check. The higher your score, the more likely you need to address hormone imbalances.
More informationIntroduction of Korean Acupuncture focusing on Saam Five Element Acupuncture and Facial Acupuncture
Introduction of Korean Acupuncture focusing on Saam Five Element Acupuncture and Facial Acupuncture Sanghoon Lee MD(Korean Medicine), MPH, PhD, DiplAc, LAc.(USA) Professor of Acupuncture & Moxibustion
More informationCapital Health Medical Center - Hopewell NEUROSURGICAL-ONCOLOGY Patient History
Capital Health Medical Center - Hopewell NEUROSURGICAL-ONCOLOGY Patient History Please take a few minutes and complete the following questions before you see the doctors so that we may learn a bit more
More informationRHEUMATOLOGY PATIENT HISTORY FORM
!! RAMOS RHEUMATOLOGY, PC RHEUMATOLOGY PATIENT HISTORY FORM Date: / / NAME: Birthdate: / / Last First M. I. Age: Sex: F M Marital status: Never married Married Divorced Separated Widowed Partnered/significant
More informationMedical History Form
Medical History Form Full Name Title: Mr/Mrs/Ms/Miss Address Date of Birth Date Telephone: Mobile: Email: How did you hear about the Garden of health? G.P s Name and Address Are you currently seeing your
More informationMedical Intake Form. Patient Name: Age : Date of Birth: Gender: Female Male Marital Status: #Children: Address: City: State: Zip:
Date: Patient Name: Age : Date of Birth: Gender: Female Male Marital Status: #Children: Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: E-mail: Person to Contact in Case of Emergency: Relationship
More informationHeadache Follow-up Visit Form
!1 Headache Follow-up Visit Form We will be unable to see you unless this form is completely filled out. We appreciate your thoroughness. Name DOB Age Today s Date Referring doctor: Primary doctor: Neurologist:
More informationNew Client Health & Wellness Paper Work
Nutritionally Yours Health Solutions 604 Macy Drive, Roswell GA 30076 678-372-2913 / alanepnd@gmail.com New Client Health & Wellness Paper Work Today's Date Patient Name: _ Parents Name (if patient is
More informationABUNDANT HEALTH CHIROPRACTIC New Patient Form PERSONAL INFORMATION. Name: Gender: M F Today's Date: / / Birth Date: / / Age: Social Security #: - -
ABUNDANT HEALTH CHIROPRACTIC New Patient Form PERSONAL INFORMATION Name: Gender: M F Today's Date: / / Birth Date: / / Age: Social Security : - - Home Address: City, State, Zip: Home Phone: ( ) Work Phone:
More information28-DAY CLEANSE GUT C.A.R.E. by Dr. Vincent Pedre. Pre-Program Medical Symptoms Questionnaire
28-DAY CLEANSE HAPPY GUT GUT C.A.R.E. by Dr. Vincent Pedre Pre-Program Medical Symptoms Questionnaire NAME ADDRESS EMAIL PHONE RATE EACH OF THE FOLLOWING SYMPTOMS BASED UPON HOW YOU HAVE FELT OVER THE
More informationHippocratus Ayurvedic Acupressure Part II Index
Hippocratus Ayurvedic Acupressure Part II Index Treatment of Hyperacidity & Gastritis / Ulcers Prevention of Loss of Energy Part I 1. Acute Gastritis 1 2. Heart and throat burning 2 3. Abdomen distention
More informationLECOM Health Ophthalmology
Patient Name: Date of Birth: New Patient Questionnaire Your answers will be used by your healthcare provider get an accurate history of your medical conditions and ocular concerns. If you are uncomfortable
More informationHorse Meridians & Ting Points
Horse Meridians & Ting Points Just like the Chakras are the main energy centers, the Meridians are the major pathways. They help to determine where the energy travels through the body. If these pathways
More informationMedical Questionnaire
MEDICIS Health Testing Center Avenue de Tervueren 236 115 Bruxelles Tel : 2/762.5.44 Medical Questionnaire Name :. Maiden name : First name :. Sex :. Address :...... Phone (private) : Office :. Date of
More informationPatient History Form
Patient Personal Information Name: Date: Age: Occupation: Employer's name: Briefly describe your daily activities at work: Sex: male female Marital Status: single married divorced widowed Spouse's name:
More informationDigestion: Small and Large Intestines Pathology
Digestion: Small and Large Intestines Pathology Dr. Ritamarie Loscalzo Medical Disclaimer: The information in this presentation is not intended to replace a one onone relationship with a qualified health
More informationDIAGNOSIS YES NO. KIDNEY YIN DEFICIENTY (Ki Yi- -) Do you have lower back weakness, soreness, or pain, or knee problems?
Answer yes or no to each of the following questions. Don t worry about what the symptoms mean; just note whether you experience them. If you have more than one--fourth to one--third yes re- sponses in
More informationNutrient Assessment Chart
Vitamin A Assessment Chart Chicken skin on backs of arms Chronic acne Dry eyes Food allergies Poor night vision Recurrent infections and colds Reduced hair growth in children Ulcers B Vitamins Afternoon
More informationDHATU ASSESSMENT. Total the number of symptoms for each tissue category. 1. BLOOD PLASMA (RASA). The clear, serum portion of the blood.
DHATU ASSESSMENT Total the number of symptoms for each tissue category. 1. BLOOD PLASMA (RASA). The clear, serum portion of the blood. Excessively dry skin Dehydration Premature graying of the hair Cold
More informationZone 1 & 2 Pupilary Zone and Nutritive Zone. Zone 3 Humoral or Inner Ciliary Zone 5/10/ Stomach Digestion 2. Intestine - Absorption
IIPA Ready Iridology Class 1 ~ Introduction, Terms and Basics Class 2 ~ Anatomy of the Eye Class 3 ~ Collarette Class 4 ~ Zones and Constitutional Types Class 5 ~ Pigmentation Class 6 ~ Lacunea Class 7
More informationPatient Health History for Fertility
Patient Health History for Fertility Name: Date: Address: City, State, Zip code Phones: Home Work: Cell: Email address: Date of Birth: Age: Occupation: Emergency contact: Ob/Gyn: Current Medications: What
More informationNEW PATIENT QUESTIONNAIRE
Consultant Name: NEW PATIENT QUESTIONNAIRE Health Care Analysis CONGRATULATIONS! You ve taken an important step in your commitment to managing your weight. We look forward to working with you. Our Program
More informationThe Food Intolerance Institute of Australia
The Intolerance Institute of Australia The Symptoms Matrix The Symptoms Matrix allows you to narrow the possibilities of your food rather than diagnose it. To get an accurate identification of your food
More informationCondition #2: What is the next important condition you would like help with, and how long ago did it begin?:
NAME _ Please take the time to fill this form out completely. The more information we have, the better we can assist you, and will make better use of your initial visit. What is the main problem you would
More informationATORIS 10, 20, 40 mg film-coated tablets
PACKAGE LEAFLET: INFORMATION FOR THE USER ATORIS 10, 20, 40 mg film-coated tablets ATORVASTATIN This leaflet is a copy of the Summary of Product Characteristics and Patient Information Leaflet for a medicine,
More informationPHYSIOTHERAPIST. Date of last visit MASSAGE THERAPIST. Date of last visit SPECIALISTS. Date of last visit WHAT ARE YOUR PRIMARY HEALTH CONCERNS?
2 PHYSIOTHERAPIST Date of last visit MASSAGE THERAPIST Date of last visit SPECIALISTS Date of last visit WHAT ARE YOUR PRIMARY HEALTH CONCERNS? WHAT IS THE PRIMARY REASON YOU ARE SEEKING CONSULTATION/TREATMENT?
More informationWhat is the most important information I should know about bortezomib? What should I discuss with my healthcare provider before receiving bortezomib?
1 of 5 6/10/2016 3:46 PM Generic Name: bortezomib (bor TEZ oh mib) Brand Name: Velcade What is bortezomib? Bortezomib interferes with the growth of some cancer cells and keeps them from spreading in your
More informationHave a healthy discussion. Use this guide to start a. conversation. with your. healthcare provider
Have a healthy discussion Use this guide to start a conversation with your healthcare provider MAKE THE CONVERSATION COUNT Here are some things you may want to reflect on and discuss with your healthcare
More informationThe Enzyme Deficiency Checklist
The Power of Enzymes Without enzymes you could not exist. Enzymes trigger thousands of call to actions in the body that are necessary for you to survive. The Role of Enzymes If your body was a factory,
More informationHASPI Medical Biology Lab 01a
! What Does It Test For? Very Low Low Glucose Electrolytes Ferritin Blood ph The glucose test measures the amount of sugar, or glucose, in the blood or urine. A very high or very low glucose test can indicate
More informationLAKES INTERNAL MEDICINE
LAKES INTERNAL MEDICINE HEALTH HISTORY QUESTIONNAIRE Please print this and complete and bring to your initial appointment. Today's Date Last Name First Name Middle Initial Date of Birth Male Female Education
More informationAcupuncture. The Art of Healing with Needles
Acupuncture The Art of Healing with Needles What is Acupuncture? Strategic placement of needles to stimulate acupoints on meridians to restore proper flow of Qi and Blood and balance of Yin and Yang to
More informationPremium Specialty: Pediatrics
Premium Specialty: Pediatrics Credentialed Specialties include: Adolescent Medicine, Pediatric Adolescent, and Pediatrics This document is designed to be used in conjunction with the UnitedHealth Premium
More informationCarlette Zottola Lac, MSTOM Acupuncture New Patient Intake Form. Patient Information. Emergency Contact Information.
Carlette Zottola Lac, MSTOM Acupuncture New Patient Intake Form Patient Information Name: Date of Birth: Age: Gender(please circle) M or F Occupation: Address: City, State, Zip: Email: Home Phone: Cell
More informationGlucose Electrolytes Ferritin Blood ph. Possible Results White Bright pink Clear White. Bright pink; fades to light pink. Light Pink fades to clear
What Does It Test For? Very Low Low Glucose Electrolytes Ferritin Blood ph The glucose test An electrolyte Ferritin is a protein The blood ph test The liver is an White blood cells measures the test measures
More informationChiropractic Applied Kinesiology Vitamins Herbs Homeopathy Health Education Classes PATIENT REGISTRATION
Chiropractic Applied Kinesiology Vitamins Herbs Homeopathy Health Education Classes PATIENT REGISTRATION Name Date Address City State Zip Home Phone Cell Phone # Work: Email Address Occupation Employer
More informationPatient Information & Health History
Patient Information & Health History Name Date Date of Birth (mm/dd/yy) Age Male Female Address City Postal Code Occupation Phone (H) E-mail Phone (C) Married Single Divorced Widowed Phone (W) Spouse s
More informationFacial Accupressure Massage. Taha Haque, D.O. CAM Workshop
Facial Accupressure Massage Taha Haque, D.O. CAM Workshop 1 10July2015 Benefits of facial accupressure Enhance local blood flow Firm and tone face and neck Mild to moderate symptomatic relief of headaches,
More informationWELCOME TO OUR OFFICE
WELCOME TO OUR OFFICE Name: Today s Date: First Middle Last Gender: Male Female Date of birth: Age: Home Address: City: State: Zip: Home Phone:( ) Cell Phone:( ) Occupation: SSN: Employer: Time of employment
More informationInitial Consultation
Today s Date: Initial Consultation Thank you for choosing Apollo Health and Wellness. Please take your time to fill out this form. It will help us to concentrate on areas of your health that need attention
More information