Auriculr Acupuncture Treatment Question Title * 1. Please fill in First Name Surname Address Address 2 County Post Code Question Title * 2. Details Below Please Mobile Number Home Number Email Address Question Title * 3. Brief history Question Title * 4. Other notes first impression Question Title * 5. Detail Left Right Handed Age M/F Kids Status Work Other Question Title * 6. Conditions Circulation Heart Problems Blood pressure Muscular / Joint Problems Respritory Issues Digestive Urinary Headaches Vertigo Nervous Issues Diagnosed Issues Other Issues Question Title * 7. General Health Medication Sleep Patterns Fluid Intake inc Coffee Appetite Bowels Menstrual Fitness Other Question Title * 8. About the treatment Duration Bleeding Ear anatomy Pictures Taken Notes Question Title * 9. Pathology Ear Helix R L Triangular Fossa R L UC Antihelix R L LC Antihelix R L Antihelix R L Scaphoid Fossa R L Crus of Helix R L Cymba Conchae R L Cavum Conchae R L Tragus R L Antitragus R L Lobe R L Back of Ear R L Question Title * 10. Treatment Plan Question Title * 11. Points Used Question Title * 12. Notes of Treatment Question Title * 13. Rection from client Question Title * 14. Forward Planning Done