Welcome New Patients
Welcome to The Center: Natural Health Specialists.  We thank you for the opportunity
to serve on your health care team and look forward to helping you reach your health
care goals naturally.  

For your convenience, you can now download all the forms we need to begin the
healing process.  Please complete these and bring them to your appointment.  These
forms provide us with information that will help us learn more about you and how we
will be able to help you achieve your health care goals.

Please also bring your most recent blood chemistry results and any other test results
related to your health.

If you have any questions regarding these forms or your appointment, please contact
us at
(919) 848-0200.  Please click here to get a map to our office.  

We look forward to working with you!
Forms Requested with Quinn Takei, Doctor of
Oriental Medicine(NM), Licensed Acupuncturist,
Chinese Herbalist, Diplomat of Oriental Medicine,
and Health & Wellness Coach

Download Adobe PDF Forms
Initial Intake Form
Informed Consent Form
Daily Food and Symptom Log
Medication-Supplement List

Printable Map


*In addition to these forms, we also request:

1) Please bring in all supplements and medications you are currently taking.
 These products vary immensely.  We would like to review these for potency,
purity, active ingredient
s, and bioavailability to ensure you are taking
products and dosages that will actually support you in health.


2) Please provide us with any lab work or blood chemistry you have had
done.  This information can be brought with you at your initial appointment,
or even better, please fax this information to 919-848-0211 so we can
review prior to your appointmen
t.
Additional Forms
Download Adobe PDF Forms
Basal Body Temperature Chart
Download Word-Excel Document Forms
Basal Body Temperature Chart