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Online Evaluation

Intake Form


This form provides us with general information about you. All of the slots give us a picture essential to correcting your balance and well-being.


Client Intake Form




Patient Information Form


This survey allows the practitioner to see all the elements of your complaints. As a result, certain patterns will be revealed that make it clear to the practitioner appropriate methods for resolving your body’s imbalance.


Patient Information Form




Constitution Assessment Form


This assessment provides a metric for determining what Chinese medicine body type you are. The Chinese Medicine practitioner will use this to discern what methods and formula will bring your imbalanced body type back to a neutral or healthy constitution. I like how the Nei Jing (ancient Chinese book) explains the aim of this tool.


Constitution Assessment Form


If there is heat, cool it;
if there is cold, warm it;
if there is dryness, moisten it;
if there is dampness, dry it;
if there is vacuity, supplement it;
and if there is excess, drain it.”

– Nei Jing, The Yellow Emperor’s Classics of Internal Medicine



Please down load all forms in either WORD format or PDF format. Then send as an attachment back:


for our viewing. We will give you feedback and recommendations on specific formulas or products on our website. The formulas will bring you back into balance and resolve critical distressful complaints in 2 hours to 5 days depending on the length and severity of your condition. Some conditions have been in existence for a long time. In order for the balanced state to anchor or where the body maintains a well state, it may be necessary to take the formula for ninety days. This will ensure the body’s ability to maintain its center of health.




After the condition has been corrected, it may be advisable to have on hand specific formulas that will be beneficial in the case of re-appearance of prior complaints. This can occur when the client chooses a diet, lifestyle or environment that supports the condition. Having the back-up plan can be very re-assuring in the case of emergencies.

Herbal Supplement Disclaimer

These statements have not been evaluated by the FDA. This product is a dietary supplement and is not intended to diagnose, cure, prevent or treat any diseases. The information here is not provided by medical (allopathic) professionals and is not intended as a substitute for medical advice. Please consult your physician before beginning any course of treatment. However, billions of people have used these products without complication. These herbal formulas have been used in conjunction with allopathic medical regimen, successfully without interference in the restorative process.

Areas of Expertise List

  • Heart & Circulation
  • Digestion
  • Elimination
  • Respiratory
  • Allergy
  • Chronic Pain
  • Athletic Injuries
  • Senior ailments
  • Chronic Fatigue
  • Immunity
  • Tumor
  • Skin Disorders
  • Weight Loss
  • Weight Gain
  • Menopause
  • Peri-menopause
  • PMS
  • Bone Density
  • Diabetes
  • Longevity
  • Cold
  • Flu
  • High blood pressure
  • Prostate problems
  • Depression
  • Anxiety
  • Detoxification
  • Impotence
  • Infertility
  • Insomnia
  • Wholesale
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2407 Moss Hill Dr.
Houston, Texas , 77080
(832) 691-5333
Hours: 10am - 5pm