Patient Intake form
Download the Patient Intake Form (as a PDF)
The intake form contains the following types of information that will be kept confidential.
- medical history
- medical information
- medical history
This information is necessary to assist Yvonne to make an accurate TCM diagnosis of the conditions for which you seek treatment. It will provide the abc's for Yvonne to create and effective treatment plan. Please complete the form before your first visit and bring the completed form with you.
My office address:
200 SW 41st Street, Suite 104
Renton, WA 98057
Located near IKEA in Renton