Client Intake Forms
Please fill out the forms before coming to your next appointment. Thank you!
Client Intake Form
New Client Intake Form
Therapy Consent Form
Client information sheet and individual consent for therapy treatment
Coaching Agreement Form
Coaching guidelines, commitment, and individual consent
Acupuncture Consent Form
Client information sheet and individual consent for acupuncture treatment
Metabolic Assessment
Assessing major health concerns and overall metabolism
Neurotransmitter - Health Questionnaire Form
Assessing physical, mental, and emotional health
Life History Questionnaire
Confidential questionnaire to gain better understanding of life history and family background
Problem Diagnosis Questionnaire (Individual)
Questions to better understand a problem or issue
HIPAA Form
HIPAA Notice of Privacy Practices
About Seasons in Our Life
Dr. Durana has provided practical, integrative, holistic services since 1980 in acupuncture, body therapy, Chinese herbal medicine, life/wellness coaching, and counseling.
Our Locations
4915 St. Elmo Ave.
Suite #504 Rm. 7A
Bethesda, MD 20814
(301) 654-0080
11250 Roger Bacon Dr.
Atrium #5, Suite 1C
Reston, Virginia 20190
(703) 716-0906
1625 K. Street NW
Suite 375B
Washington, DC 20006
(202) 906-0533
2265 Cedar Cove Ct.
Reston, VA 20191
(703) 716-0906
