Wellness Progress Review

A structured self-review of how your TCM care is working so far. Rate each area honestly, comparing when you started with how you feel today. Your answers help your practitioner adjust your treatment and plan the next phase of care.

Section 1 — About This Review

Full name:

Date of this review:

Roughly when did your care begin?

Number of sessions attended so far:

Section 2 — Main Complaint: Then vs. Now

What was the main issue you came in for?

Rate the severity of your main complaint on a 0–10 scale (0 = none, 10 = worst):

Section 3 — Whole-Body Check-In

Rate each area from 1 (poor) to 5 (excellent), then and now:

Section 4 — Herbs & Home Plan Adherence

How closely did you follow the herbs and home plan? (1 = not at all, 5 = fully):

I took my herbs consistently

I followed the dietary guidance

I kept up with lifestyle recommendations (exercise / rest / stress)

I experienced side effects or trouble tolerating the herbs

Describe any side effects or parts of the plan that were hard to keep up:

Section 5 — What Changed

What has improved most since you started?

What has not improved, or has gotten worse?

Any new symptoms or life changes the practitioner should know about:

Section 6 — Goals for the Next Phase

What would you most like to focus on next?

How would you like to continue? (check all that apply)

Continue at the current frequency

Reduce to maintenance visits

Take a break and reassess later

I would like to discuss options with my practitioner

Section 7 — Satisfaction & Consent

Overall satisfaction with your care so far (1 = poor, 5 = excellent):

The information I have provided is accurate to the best of my knowledge.

I consent to my practitioner using this review to adjust my treatment plan.

Section 8 — Signature

Signed (printed name):

Date:

Thank you for taking the time to reflect. Your practitioner will review your answers alongside pulse and tongue findings to shape the next phase of your care.