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Welcome
Welcome
Please take the time to fill out this short questionnaire, so that we can get you an appointment with Dr. Bey. If you have been treated before by Dr. Bey, then you will quickly be rerouted to the booking page. If you have not been seen by Dr. Bey before, the information requested is quite necessary to do so. 
33Questions
Bey Acupuncture Assessment
  • 1
    Questions touch topics around mental health, physical health, and lifestyle.
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  • 2
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  • 3
    Pick a Date
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  • 4
    • Male
    • Female
    • Non-Binary
    • Prefer Not To Say
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  • 5
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  • 6
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  • 7
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  • 8
    Choose all that apply
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  • 9
    Please choose which time during the day, you experience your condition.
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  • 10
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  • 11
    1 being low, 10 being high
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  • 12
    Choose all that apply
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  • 13
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  • 14
    Choose all that apply
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  • 15
    Please answer honestly, so we can provide the best service for you.
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  • 16
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  • 17
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  • 18
    1 being poor, 10 being superb.
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  • 19
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  • 20
    • Dull
    • Acute
    • Throbbing
    • On and Off
    • Circumstantial
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  • 21
    Select all that apply
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  • 22
    • Often Hungry
    • Sometimes Hungry
    • Rarely Hungry
    • Never Hungry
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  • 23
    • Often Thirsty
    • Sometimes Thirsty
    • Rarely Thirsty
    • Never Thirsty
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  • 24
    • Always Hot
    • Always Cold
    • N/A
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  • 25
    Select all that apply
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  • 26
    • Weekly
    • Bi-Weekly
    • Monthly
    • Quarterly
    • Yearly
    • N/A
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  • 27
    • Weekly
    • Bi-Weekly
    • Monthly
    • Quarterly
    • Yearly
    • N/A
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  • 28
    1 being very unhealth, 10 being incredibly healthy
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  • 29
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  • 30
    • Daily
    • Weekly
    • Bi-Weekly
    • Monthly
    • Quarterly
    • Yearly
    • N/A
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  • 31
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  • 32
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  • 33
    By sharing your email and selecting submit, you agree to subscribing for future promotions and updates, regarding to Bey Acupuncture.
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