Print them, fill them out at your convenience,
and bring them to your New Patient appointment, or scan and email them back to dbacupuncture(at)gmail.com
Please download, complete and return these forms
before or at your next visit.
(Note: this is a fillable PDF file, if you want to do it all electronically. It is a bit tricky though…
- Download the file to your computer and open it in Adobe Acrobat Reader.
- Click on the right hand menu item called “Fill & Sign.” It will ask you who needs to sign, Choose “you” and click “fill & sign”.
- It takes you back to the forms, but now there is an extra little toolbar at the top, including a small pen tip icon that says “sign.” Like this…
- Click on the pen icon to create your initials and signature.
- It will then put your initials or signature on the page, and you can move it to the appropriate field. (Do not click on the initial or signature fields, or you will be asked to create a digital ID.)
- Continue to click on the pen icon, to put your initials or signature on the pages, and then move them to the correct locations.
- Click on the “Print Name” and “Date” fields in the forms to fill them in.
- Save the filled-in file, and email it dbacupuncture(at)gmail.com.)
What can I expect as a new patient?
As a new patient, you will spend up to 90 minutes with Dr. Dawn Potter-Balusik. She will personally review your health history, as well as your current health concerns. In addition to the detailed health questionnaire found at the above link, you will also be asked questions verbally.
Though some questions may not seem relevant to your main health concern, each answer helps to paint a picture of your overall pattern of imbalance, which is essential to determining your Oriental medical diagnosis and treatment strategy.
Please bring a list, or the actual bottles, of all pharmaceutical medication and supplements you are taking, so Dawn can be sure to avoid potential interactions.
Another part of the diagnostic process involves feeling the pulses on both of your wrists, as well as looking at your tongue, which serves as a map of your internal body. Dawn may also palpate your abdomen and any major areas of discomfort you have. Drawing from all of this information, Dawn will determine your Oriental medical diagnosis and create a treatment strategy for you.
During your initial visit, you will receive an acupuncture treatment and most patients receive nutritional recommendations as well as Chinese herbs and/or nutritional supplementation. Dawn may also give you specific stretches, breathing techniques, self-care ideas or exercises to do for your condition.
How many treatments will I need?
This is generally determined by the severity of your condition, how long you’ve had it, and how healthy you are otherwise. Depending on the severity of your symptoms, you will receive treatments 2 times per week to 2 times per month, with treatments less frequent as your condition improves. Generally, 6 to 12 weekly treatments are adequate to make a significant difference in most conditions. Then visit frequency may be reduced.
What do I need to do before my treatment?
Wear loose, comfortable clothing. It is helpful if long sleeves and pant legs can be comfortably pulled up over your elbows and knees, and that your abdomen is easily accessible.
It is best to have eaten a light meal or snack shortly before coming in for treatment. You don’t want to be uncomfortably full, but it is also not good to be hungry during your treatment; like exercise or massage therapy, acupuncture can lower your blood sugar level.
*Please do not drink alcohol before or immediately after your treatment.
What do I need to do after my treatment?
Avoid hot showers, vigorous workouts and sexual activity for 8 to 12 hours after your acupuncture treatment, since these activities can disrupt the effects of the treatment, as can drinking alcohol or partaking of any type of mood altering substance, apart from prescribed medications.
Also, after your first treatment, be aware of how you are feeling. It is important for you to be aware of any changes in symptoms or conditions between treatments. Sometimes even the smallest details are important in understanding your progress.
Sensitivity may last for a short time where the needles were inserted. Occasionally, bruising may develop at the insertion point. If so, apply an ice compress and/or liniment to the bruised area. It is temporary and will clear up on its own.
Take your herbs as directed. This will ensure the best possible results. If you have any questions about how you are responding to the herbs, please call the office. Due to the fibrous nature of the herbs, some people may initially experience bloating, gas or changes in elimination; if any of these symptoms last more than a day or two, please call to discuss an adjustment in dosage or formula.