PCOS & TCM Initial Assessment:

Welcome! Please take some time to fill out this form. The information you provide will help me understand your unique health picture from a holistic perspective, which is the foundation of Traditional Chinese Medicine (TCM).

Unlike conventional medicine, TCM views polycystic ovary syndrome (PCOS) not just as a set of symptoms but as a deeper imbalance within the body. By gathering these details, we can create a personalized treatment plan focused on restoring balance and addressing the root cause of your symptoms. Your honesty is key to a successful journey towards better health. All information you provide will be kept strictly confidential.

What are your primary concerns or symptoms related to PCOS

Please describe them in your own words, including frequency and severity.

How would you describe your menstrual cycle?

Please include the typical length of your cycle, the duration of your period, and the characteristics of your flow (e.g., heavy, light, clots, pain).

Are you currently experiencing any other health issues or symptoms that may seem unrelated to your cycle?

This includes things like digestive problems, sleep disturbances, acne, hair loss, or emotional changes.

Yes

How would you describe your stress levels and emotional state?

In TCM, the Liver is closely related to emotions and can be a key factor in PCOS. Please describe any feelings of irritability, frustration, or sadness you may experience.

Please provide details about your diet and lifestyle

Include what you typically eat in a day, your exercise habits, and any other relevant lifestyle factors like sleep patterns or work schedule.