Prospective Clients Screening Form

This is a unique practice and offering. We provide highly affordable care to a very specific population. Please read through and fill this application form to find out if we can be of service to you. Answering “No” to the questions generally indicates that Bardo Acupuncture is NOT the right practice for you at this time but please email us at BardoAcupuncture@gmail.com if you have a special situation you’d like us to consider.

We will reach out to arrange a free New Client Call if your responses to this form indicate you would be a great fit for our practice!

Thank you for your response. ✨

Name

Phone number

Were you referred to us by someone? Please tell us their name!

Practice Vibe & Philosophy: This practice offers a relational, unhurried space for gentle support. We specifically support women seeking consistent holistic care in a less formal, non-hierarchical, non-medicalized setting. Does this approach align with what you’re looking for? (Yes / No)

Health Conditions Treated: We are happy to consider diverse situations and clientele, but this practice is currently dedicated to supporting women experiencing stress, anxiety, depression, bothersome hormonal situations such as PMS/PMDD, and those navigating difficult peri/menopausal transitions. We are also happy to help with hormone-related migraines. Is this generally what you are seeking care for? (Yes / No)

Dr. Linden is currently in a season of semi-retirement to support her own midlife menopause process. During this time she is offering affordable sliding-scale care as a community service to a small number of women in need. She works with clients who are looking for consistent weekly support -which is what is required for addressing women’s hormonal/mental health. Can you commit to weekly treatments? (Yes / No)

As a community service, Dr. Linden offers her services on a very affordable sliding scale to ensure financial accessibility isn’t a barrier for women in need, especially young women experiencing PMDD and mental health challenges, and women who feel like perimenopause it greatly disrupting their lives. The average weekly price per Adaptogenic Acupuncture treatments is about $40 plus or minus $5-$10. If special circumstances arise for regular clients, Dr. Linden offers additional support at low- or no- extra weekly cost. In return, she asks for mutual respect, open communication, weekly attendance, commitment to keeping appointments and reschedules with appropriate notice, and a dedication to taking responsibility for one’s own healing process. Can you agree to this energy exchange? (Yes / No)

What is the ideal weekly price range that would make it possible for you to receive weekly treatments?

Dr. Linden was trained as a generalist in both Chinese Medicine and Ayurveda and can address most health conditions that arise in established clientele, but she does NOT treat new clients seeking care for: Primary complaints of pain and sports medicine without mental health or hormonal challenges, cancer support, clients seeking IVF and fertility support who are actively trying to become pregnant, and those experiencing untreated acute mental health crises/psychosis. She also does not treat children or teens. She will consider male clients seeking support for anxiety and depression on a case-by-case basis. She is only conducting Ayurvedic medicine consultations for established clients. If you have a special situation or request, please email her at BardoAcupuncture@gmail.com to explain your situation. I have read and understood the excluded populations/conditions (Yes / No)

Is there anything else you would like to tell us?

Dr. Linden’s office is NOT accessible to those with mobility constrains. You must be able to manage walking down a sloped driveway and on a gravel walkway. I understand! ( Yes / No)

BARDO ACUPUNCTURE & AYURVEDA

The Art & Science of Natural Health

Prospective Clients Screening Form

We will reach out to arrange a free New Client Call if your responses to this form indicate you would be a great fit for our practice!

Thank you for your response. ✨

We will reach out to arrange a free New Client Call if your responses to this form indicate you would be a great fit for our practice!

Thank you for your response. ✨

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