7TCM Online Consultation

Physical Condition:

Nature of Work:

Marital & Parental Status:

Living Environment:

2.1 Disease Course & Main Health Concerns (Please rank by severity, 1 being the most severe)

Common Options for Reference:

Regimen Goals:

Expected Regimen Duration:

3.1 Cold/Heat Sensation

Overall, do you feel more sensitive to cold or heat?

Areas sensitive to cold:

Degree of cold sensitivity:

Areas sensitive to heat:

Type of heat sensation:

Sensitive to air conditioning/fans?

Hands and feet in winter:

Hands and feet in summer:

3.2 Sweating

Overall sweat volume:

When do you sweat easily?

Sweating areas:

Sweat characteristics:

Feeling after sweating:

4.1 Head

Do you have headaches?

Headache location:

Headache nature:

Headache timing:

Do you have dizziness?

Dizziness nature:

Dizziness timing:

4.3 Thirst & Drinking

Do you feel thirsty?

Preferred drink temperature:

Daily water intake?

Feeling after drinking water:

4.4 Ears & Hearing

Is your hearing normal?

Do you have tinnitus?

Tinnitus sound:

Tinnitus persistence?

Do you have a feeling of fullness in the ears?

4.5 Spirit & Mentation

Mental state: