“Let food be thy medicine and medicine be thy food” – Hippocrates

Self-Assessment Health Profile

This profile can be used as an educational device as well as a diagnostic tool. It will aid you in becoming acquainted with the language of Chinese medicine.
Check the symptoms you have experienced during the last six months.
Circle and check those that have been most troublesome.

if you prefer to download the form and fill it out by hand – click here

This Health Profile is excerpted from Between Heaven and Earth: A Guide to Chinese Medicine (Beinfield & Korngold, Ballantine, 1991). This book is a good resource to help you understand more about Chinese medicine, available through local bookstores.