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Acupuncture Intake Forms - Vortala · Low Back Pain / Weakness Weak / Sore Knees Decreased Bone Density Feel cold Easy Low / Excess Libido ... diagnosis and treatment as my sole remedy

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Page 1: Acupuncture Intake Forms - Vortala · Low Back Pain / Weakness Weak / Sore Knees Decreased Bone Density Feel cold Easy Low / Excess Libido ... diagnosis and treatment as my sole remedy

Page 2: Acupuncture Intake Forms - Vortala · Low Back Pain / Weakness Weak / Sore Knees Decreased Bone Density Feel cold Easy Low / Excess Libido ... diagnosis and treatment as my sole remedy

Page 3: Acupuncture Intake Forms - Vortala · Low Back Pain / Weakness Weak / Sore Knees Decreased Bone Density Feel cold Easy Low / Excess Libido ... diagnosis and treatment as my sole remedy

Page 4: Acupuncture Intake Forms - Vortala · Low Back Pain / Weakness Weak / Sore Knees Decreased Bone Density Feel cold Easy Low / Excess Libido ... diagnosis and treatment as my sole remedy

Page 5: Acupuncture Intake Forms - Vortala · Low Back Pain / Weakness Weak / Sore Knees Decreased Bone Density Feel cold Easy Low / Excess Libido ... diagnosis and treatment as my sole remedy

Page 6: Acupuncture Intake Forms - Vortala · Low Back Pain / Weakness Weak / Sore Knees Decreased Bone Density Feel cold Easy Low / Excess Libido ... diagnosis and treatment as my sole remedy

Page 7: Acupuncture Intake Forms - Vortala · Low Back Pain / Weakness Weak / Sore Knees Decreased Bone Density Feel cold Easy Low / Excess Libido ... diagnosis and treatment as my sole remedy

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