Consent

Current as of: 01 September 2019
Please read this information carefully, and ask us if there is anything that you do not understand.


Introduction
Acupuncture is a form of therapy in which fine needles are inserted into specific points on the body.


Safety
Acupuncture is safe. Serious side effects are very rare – less than one per 10,000 treatments.


Potential side effects
•Minor bleeding and bruising (3%)
•Temporary aggravation of symptoms (3%)
•Mild pain at the needle site (1%)
Dizziness, fainting, nausea, headache and infection (0.1 ~ 1%)
• Pneumothorax and death (less then 2 per 1 million)


Specific concerns
If you have any specific concerns regarding the safety, please discuss with us at any time. We shall also inform you if there are particular risks that apply in your case.


Fee
Information on fees are listed on the website. If you want to clarify, please discuss with us before the treatment.


Statement of consent
I confirm that I have read and understood the above information, and I consent to having acupuncture treatment. I understand that I can refuse treatment at any time.

Signature

Print name in full

Date

Patient information

Fee and rebate

Conditions we treat

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