Jade Buddha Herbs - chinese medicine, acupuncture - Randwick, Sydney

Online Consultation


Before filling out your details, please first read our disclaimer and explanation. This online consultation is not intended to replace the clinic visit which may be the only way to correctly determine the best procedure for treatment. However, it may help us in forming a diagnose before an initial visit, in person, to our clinic. Read more here.

Your Name*:
Contact Phone:
Mobile Phone:
Address:
Email*:
Occupation:
Age:
Gender: male female


Please Describe your main problem in detail:


Brief health history - include investigations such as laboratory tests, x-rays, ultrasound and treatments:


If you have been diagnosed by your GP, what is his diagnosis?


Please list all medications you take:


Pulse Rate:         Blood Pressure:

Further comments about pulse and/or blood pressure:


Temperature:

 Remarks about Temperature:

Perspiration:
 Remarks about Perspiration:
Emotions/Mind:
 Remarks about Emotions/Mind:
Energy Level:
 Remarks about Energy Level:
Sleep:
 Remarks about Sleep:
Complexion:
 Remarks about Complexion:
Skin:
 Remarks about Skin:
Hair:
 Remarks about Hair:
Eyes:
 Remarks about Eyes:
Ears:
 Remarks about Ears:
Nose:
 Remarks about Nose:
Throat:
 Remarks about Throat:
Mouth, Lips & Teeth:
 Remarks about Mouth, Lips & Teeth:
Head and Neck:
 Remarks about Head and Neck:
Chest:
 Remarks about Chest:
Stomach:
 Remarks about Stomach:
Bowel Movement:
 Remarks about Bowel Movement:
Urination:
 Remarks about Urination:
Tongue:
 Remarks about Tongue:
Reproduction - Men:
 Remarks about Reproduction - Men:
Gynaecological Problems:
 Remarks about Gynaecological problems:









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© Jade Buddha Herbs 2004
129 Belmore Rd, Randwick, NSW 2031, Australia.     Ph. 61-2-9310-0493