XIA FENGLING | 中医线上咨询申请 / TCM Online Intake

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中医线上咨询申请TCM Online Consultation

TCM Consultation Intake Form

这是预约确认后的完整病历表。 This full intake form is for confirmed bookings.

如果尚未确认，请先通过 WhatsApp 提出预约。平台会了解需求与轻重缓急，再安排合适医师；不会在 WhatsApp 直接诊断。 If your booking is not confirmed, contact us on WhatsApp first. The platform will review your need and urgency, then match you with a suitable practitioner. No diagnosis is made on WhatsApp.

尚未确认？先匹配医师Not confirmed? Request practitioner matching

本问诊单目前以中文填写为主。如需英文协助，请通过 WhatsApp 联系我们安排。 This form is primarily completed in Chinese. For English assistance, please contact us via WhatsApp.

本平台提供专业中医线上咨询资料收集服务。所有资料将由大马合法注册中医师亲自查阅、辨证并跟进。所有沟通方式默认采取视讯 (Video Call)。 This platform collects data for professional TCM online consultations. All cases will be reviewed and followed up by a registered TCM practitioner in Malaysia. All communications default to Video Call.

我理解线上咨询不能完全替代线下检查，且不处理急症。 I understand online consultation cannot fully replace in-person exams and does not handle emergencies.

我同意提交健康资料用于中医师评估及病历记录。 I consent to submitting my health data for TCM practitioner evaluation and medical records.

基本资料与医师Personal Info & Doctor

Profile Setup

姓名Full Name *

性别Gender *

年龄Age *

出生日期Date of Birth *

国籍 / 地区Nationality / Region *

身份证号 / 护照号National ID / Passport No. *

支持中国居民身份证、马来西亚 IC 及全球护照/有效证件号（用于身份核对与病历建档）。Supports Chinese Resident ID, Malaysian IC, and international passports/IDs for verification and record keeping.

所在城市City *

WhatsApp 或手机号WhatsApp / Mobile *

微信号 (若使用微信联系)WeChat ID (Optional)

Email / Optional

紧急联系人Emergency Contact

姓名Name *

电话Phone No. *

您是否未满 18 岁？Are you under 18 years old? *

是Yes

否No

医师匹配方式Practitioner Matching *

如果不确定该预约哪位医师，可先选择由平台根据您的问题方向推荐合适医师。 If you are not sure which practitioner fits your case, choose platform matching and we will recommend a suitable practitioner based on your concern.

不确定，先由平台推荐合适医师Not sure - let Fengling TCM recommend 适合第一次咨询、症状方向不清楚，或希望先由客服协助分流的用户Best for first-time users, unclear concerns, or cases needing practitioner matching before booking

陈湘萍中医师Dr. Tan Xiang Ping 擅长：脾胃、睡眠、女性体质Specialties: GI, Sleep, Women's Health

陈则铭中医师Dr. Chen Ze Ming 服务关注：慢性骨关节问题、筋伤调理与骨伤后功能恢复Focus: Chronic joint concerns, tendon injuries, and post-injury functional recovery

您是否曾接受过本平台或本医师看诊服务？Have you previously received consultation from us? *

（若选择复诊，将跳过详细病历填写，直接进入配套选择）(If Returning, you will skip detailed history and jump to package selection)

是 (复诊患者)Yes (Returning)

否 (初诊患者)No (New Patient)

主诉 (初诊)Main Complaint (New)

Chief Complaint

1. 您这次最想解决的问题是什么？(尽可能详细描述)1. What is the primary issue you want to address? (Be as detailed as possible) *

2. 这个问题出现多久了？2. How long have you had this problem? *

3. 症状是怎样开始的？3. How did the symptoms begin? *

4. 症状严重程度 (0=无，10=最严重)4. Severity Score (0=None, 10=Most Severe)

5. 什么时候最明显？5. When is it most noticeable?

6. 什么会让症状加重？6. What aggravates the symptoms?

7. 什么会让症状缓解？7. What relieves the symptoms?

详细症状情况 (初诊)Symptom Details (New)

Symptom Inventory

A. 胃肠问题 (请尽可能详细描述您的肠胃状况)A. Gastrointestinal Issues

B. 疼痛问题 (部位与性质)B. Pain Issues (Location & Nature)

C. 睡眠与压力状况C. Sleep & Stress

D. 女性相关问题 (若不适用请留空)D. Women's Health (Optional)

中医线上咨询申请TCM Online Consultation

基本资料与医师Personal Info & Doctor

紧急联系人Emergency Contact

主诉 (初诊)Main Complaint (New)

详细症状情况 (初诊)Symptom Details (New)

选择调理配套与提交Select Plan & Submit

中医线上看诊服务TCM Consultations

初诊线上看诊 (30分钟)Initial Consult (30 mins)

深度调理线上看诊 (31-60分钟)In-Depth Consult (31-60 mins)

方药调整微调 (15分钟视讯)Follow-up Consult (15 mins)

月度调理配套 (两次看诊) 期限 30 天 Monthly Consult Plan (2 Sessions) 30 Days

季度调理配套 (6次看诊) 期限 90 天Quarterly Consult Plan (6 Sessions) 90 Days

气功指导与抗压配套Qigong & Stress Relief

单次自然门气功指导与答疑Single Qigong Session

月度入门配套 (气功)Monthly Qigong Intro

自然门气功季度调理配套Quarterly Qigong Plan

选择提交方式Choose Submission Method