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Client Intake Forms

Please fill out the forms before coming to your next appointment. Thank you!

Patient COVID Form

Patient COVID Form

 

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 - Room 7A
Bethesda, MD 20814
(301) 654-0080

1875 Campus Commons
Suite 210 - Room 11A
Reston, Virginia 20191
(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

Due to the recent developments and to assist with health and wellbeing, Seasons in Our Life have expanded options for engagements to include video sessions.

Please call for details and scheduling.