TCM Consultation Form

1. Personal Information

2. Tongue Photo Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.
Please upload 1-3 clear photos of your tongue taken in natural light. Extend your tongue fully and avoid filters artificial lighting or color distortion.

3. Primary Health Concerns

What are your main health concerns or symptoms recently Please describe when they started how often they occur and anything that makes them better or worse.

4. Lifestyle & Daily Habits

Please briefly describe your daily lifestyle including sleep diet and physical activity.

5. Common Symptoms (Select all that apply)

Common Symptoms (Select all that apply)

7. Consent

Consent