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Medical Info
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General Health
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Current Treatment
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Conditions
Well Being
Exercise
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TMJ (Jaw)
Ear Pressure
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Difficulty Chewing
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Difficulty Opening Jaw
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LIV/GB (Wood)
Poor Circulation
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HT/SI (Fire)
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Oncology
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Treatment: Surgery
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Lymph Nodes Removed
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Treatment: Chemotherapy
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Treatment: Radiation
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Area of Radiation
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Female Health
Currently Pregnant
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Area of Complaint
Left Side of Neck
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Right Side of Neck
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Left Side of Upper Back
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Right Side of Upper Back
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Left Side of Mid Back
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Right Side of Mid Back
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Left Side of Low Back
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Right Side of Low Back
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Chest
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Abdomen
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Left Arm
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Right Arm
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Left Shoulder
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Right Shoulder
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Left Elbow
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Right Elbow
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Left Wrist
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Right Wrist
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Left Hand
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Right Hand
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Left Leg
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Right Leg
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Left Gluteal
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Right Gluteal
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Left Hip
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Right Hip
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Left Groin
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Right Groin
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Left Knee
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Right Knee
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Left Ankle
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Right Ankle
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Left Foot
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Right Foot
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Sacrum
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Tailbone (coccyx)
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Headaches
Tension
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Chronic Daily Headache
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Cluster
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Headaches
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Rebound
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Other Headaches
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Musculoskeletal
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Fracture
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Amyotrophic Lateral Sclerosis (ALS)
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Fibromyalgia
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Carpal Tunnel Syndrome
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Osteoporosis
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Muscular Dystrophy
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Psoriatic Arthritis
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Bone Disease
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Whiplash
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Ankylosing Spondylitis
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Plantar Fasciitis
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Compartment Syndrome
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Sinus Problems
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Jaw Pain (TMJD)
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Dislocation
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Artificial Joints / Special Equipment
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Osteoarthritis
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Joint Injury
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Tendonitis/Bursitis
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Gout
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Scleroderma
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Scoliosis
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Arthritis
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Other Musculoskeletal
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Cardiovascular
Phlebitis
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Aneurysm
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Rheumatic Heart Disease
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Cardiac Arrhythmia
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High Blood Pressure
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Coronary Artery Disease
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Cardiovascular Conditions
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Blood Clots
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Low Blood Pressure
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Blood Pressure
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Raynaud Disease
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Lymphedema
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Congestive Heart Failure
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Acute Coronary Syndrome
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Heart Attack
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Atherosclerosis
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Chronic Ischemic Heart Disease
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Congenital Heart Defect
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Angina
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Pacemaker
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Varicose Veins
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Pericarditis
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Myocardial infarction
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Heart Disease
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Other Cardiovascular
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Blood
HIV/AIDS
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Anemia
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High Cholesterol
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Haemophilia
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HIV
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Hypercoagulability
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Thrombosis/Embolism
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Hepatitis
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Bleeding Disorder
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Skin
Melanoma/Carcinoma
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Skin Conditions
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Plantar's Wart
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Rash
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Hypersensitive Reactions
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Eczema
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Infectious Skin Conditions
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Athletes Foot
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Rosacea
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Neurological
Shingles
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Multiple Sclerosis
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Burning
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Vertebral and Spinal Cord Injury
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Transient Ischemic Attacks (TIA)
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Brain Injury
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Sciatic Pain
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Stroke
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Cerebral Vascular Accident (Stroke)
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Epilepsy
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Parkinsons
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Cerebral-vascular Accident
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Herniated Disc
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Other Neurological
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Respiratory
Asthma
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Other Respiratory
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Kidney
Chronic Kidney Disease
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Congenital Kidney Disease
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Kidney Stones
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Gastrointestinal
Digestive Conditions
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Constipation
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Endocrine
Hyperthyroidism
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Hypothyroidism
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Diabetes
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Hearing
Hearing Loss
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Vertigo
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Tinnitus
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Immune
Hodgkin Lymphoma
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Allergies
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Anaphylaxis
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Infectious Mononucleosis
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Non-Hodgkin Lymphoma
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Lupus
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Rheumatoid Arthritis
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Miscellaneous
Mental Health Issues
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Surgical Pins or Wire
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Other Medical Conditions
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Other Diagnosed Diseases
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Prenatal (check boxes to enter details below)
Due Date
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Trimester
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Weeks Pregnant
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Number of previous pregnancies/births?
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Anemia
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Blood Clot (Phlebitis)
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Diabetes
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Leg Cramps
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Nausea
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Pre-eclampsia (toxemia)
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Sciatica
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Allergy to Nut Oils
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High Risk Pregnancy
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Anxiety
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Depression
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