Informed Consent To Receive Acupuncture Treatment

  • By booking an appointment with Pokey Practice Acupuncture’s acupuncturists, licensed in the State of Colorado, you agree to receive treatments.
  • You understand that these treatments may include acupuncture,  moxibustion, spiritual healing, energetic healing, bleeding techniques, essential oils, stone balancing, flower essence or dietary and lifestyle recommendations.
  • This authority shall extend to remedying any unforeseen conditions or reactions to treatments.
  • You understand that Pokey Practice Acupuncture uses only sterile disposable needles and maintains a clean and safe environment.
  • You understand that these treatments are all safe, natural methods of healing.
  • You recognize the potential risks and benefits of these procedures as described on the page below.

Potential risks and benefits

  • By scheduling your acupuncture appointment you understand that you may experience relief of symptoms, improved sense of well-being, reduced stress and an overall balance of bodily energies.
  • You understand that these treatments may lead to prevention or elimination of your main complaints.
  • You understand that there are uncommon but possible side effects of acupuncture treatment.
  • These possible side effects may include minor pain or soreness in the treatment areas that may last up to a few days, temporary bruising or swelling, sensations of heat, cold, tingling or numbness, skin irritation or slight bleeding at needle site, generalized fatigue or even temporary aggravation of symptoms.
  • You also understand that there are very rare side effects to acupuncture treatment that may include infection at needle site, dizziness, nausea, fainting, broken needles or organ puncture.
  • By scheduling your acupuncture appointment with Pokey Practice Acupuncture, you agree to contact your acupuncture practitioner immediately if you experience any problem which you associate with the treatments listed above.
  • You also agree that you will seek immediate help from a physician or hospital if you experience a medical emergency.
  • During the course of treatment, You also agree to inform your acupuncturist of all health issues and medication changes.
  • You will notify your acupuncturist should you become pregnant.
  • By scheduling your acupuncture appointment, you also agree to inform your acupuncturist if you are in the process of trying to get pregnant.
  • You understand the importance of this information being so that my acupuncture practitioner can avoid points that could induce premature labor or miscarriage.

 

  • You understand that Pokey Practice Acupuncture keeps a detailed record medical and other information concerning your treatment.
  • You understand the clinical and administrative staff of Pokey Practice Acupuncture may review your records, but that all of your records will be kept confidential and will not be released without your written consent.
  • You understand that the only exception to this will be when bound by law to do so.
  • You understand that Pokey Practice Acupuncture abides by state and federal regulations regarding patient privacy.
  • You know and understand that you may ask for more information regarding these regulations at anytime.

 

  • You understand that You have the right to request to receive a copy of your treatment records as maintained by Pokey Practice Acupuncture.
  • You also understand and agree that a copy will be released to me in place of the original on your request.

 

  • By scheduling your acupuncture appointment you are agreeing to not expect the clinical staff of Pokey Practice Acupuncture to be able to anticipate and explain all possible risks and complications of treatment.
  • You are also in agreement that you wish to rely on the clinical staff to exercise judgment during the course of treatment.
  • By scheduling an appointment with Pokey Practice Acupuncture, you voluntarily consent to the above procedures and policies.
  • You agree to this realizing that there is no implied or stated guarantee of success or effectiveness of a specific treatment or series of treatments regarding the cure or improvement of your conditions.  
  • You hereby release the acupuncturists of Pokey Practice Acupuncture from any and all liability which may occur in connection with the above mentioned procedures.
  • You agree that the above applies in all situations, except for those where failure to perform the treatments with appropriate skill as required by their licenses occurs.
  • You also understand that you are free to withdraw your consent and to discontinue participating in these procedures at any time.