All procedures will be clearly explained prior to treatment.
Written consent from a Guardian or Parent needs to be obtained before treating minors (aged 16 years and under).
You are welcome and encouraged to bring a support person with you while you have this treatment.
I have the right to decline or withdraw my consent to treatment at any given time.
Due to the nature of the treatment, the practitioner may need to touch or palpate different areas on your body.This may help in the diagnosis or in locating acupuncture points.
You may be asked to remove certain items of clothing to enable better access to different parts of your body. You can expect to have a towel or blanket to cover you.
Some questions asked may seem irrelevant to you, however, they are asked to enable your Acupuncturist to make both a holistic and accurate diagnosis.
If you feel uncomfortable in any way at any stage of the treatment for any reason, please tell your Acupuncturist, as there may be some way to make you feel more comfortable. Every effort will be made to make you feel as comfortable as possible.
I understand that methods of treatment may include, but are not limited to, acupuncture, moxibustion, cupping, gua sha, electrical stimulation, ear acupuncture, breathing techniques, exercise therapy, Tuina (Chinese Medical Massage), lifestyle and dietary advice.
I have been informed that acupuncture is a safe method of treatment, but that it may have side effects, including bruising, numbness or tingling near the needling site that may last a few days, and possibly dizziness or fainting. Bruising is a common side effect of cupping and gua sha.
I understand that I should not make significant movements while the needles are being inserted, retained or removed.
I must inform the Acupuncturist if there is any chance of being pregnant or are pregnant.
I do not expect the Acupuncturist to be able to anticipate and explain all possible risks and complications of treatment.I wish to rely on the Acupuncturist to exercise judgment during the course of treatment, which the Acupuncturist thinks at the time, based upon the facts then known, is in my best interest.I understand that results are not guaranteed.
I consent to the collection and passing of information between medical practitioners, specialists, health care professionals, hospitals, and insurance companies. That all information will be collected, held and used in terms of the Privacy Act 1993 and the Health Information Privacy Code 1994.
I have the right to see my clinical records and information collected.
I understand that a minimum of 24 hours notice is required for appointment cancellations. Notice given on the day of the appointment will incur a late cancellation fee. All ‘no shows’ will incur the full cost of the treatment.
Full payment for services provide must be made at the time of the treatment via eftpos or online banking. Credit card payments are not accepted.
From time to time, the practitioner may be operating 2 treatment rooms for follow-up treatments at the same time. This will not affect the level of service and care that you will be receiving.
ACC treatments will only be accepted for injuries that have occurred within 12 months of the date of the injury. You must provide the Acupuncturist with a currentACC45 number, date of injury and read code(s) when booking your appointment. Otherwise the treatment will be classified as a ‘private’ treatment and charged accordingly. If you have received ACC treatments from another service provider then a referal letter to receive acupuncture must be obtained from that provider.
By voluntarily signing below, I show that I have read or have had explained, the consent for treatment and have been told about the risk and benefits of acupuncture and other procedures. I have also had the opportunity to ask questions. I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment.
I hereby request and consent to the performance of acupuncture treatments and other Traditional Chinese Medical procedures, by the Acupuncturist named below and/or other registered Acupuncturists who now or in the future treat me while working or associated with, or serving as a back-up for the Acupuncturist named below.
From time to time, Mei Ling Acupuncture & Natural Health Clinic may send you newsletters and information via email to keep you informed of the latest health trends, as well as lifestyle tips to help you on your journey to achieve good health.
