Informed Consent
I hereby request and consent to the performance of acupuncture treatments and other procedures within the scope of the practice of acupuncture and Chinese Medicine on me at Bribie Acupuncture. As with any health care treatment, it is very important that you read and understand any risks involved with traditional Chinese medicine so that you can properly consider the risks and benefits that may apply to you. Acupuncture treatment involves the insertion of fine, sterile needles into specific points on the body to relieve pain and/or to help stimulate the proper flow of the body’s normal regulation.
During your acupuncture treatment, you might experience mild sensations including pricking on needle insertion; tingling; aching; soreness; numbness; fullness; distension; pressure; heaviness; warmth. These sensations are a normal part of acupuncture treatment. The quality and strength of sensation varies, depending on the individual, the condition and its severity. If at any point you do experience feelings of discomfort or sharp pain that does not subside, please tell your practitioner immediately so that they can ensure you are comfortable. This likely involves readjusting or reinsertion of the needle or omitting the point. Some unintentional bleeding from points may occur from time to time, which is harmless and often of diagnostic value to practitioners. Mild bruising may occur on one or more points and will usually fade within a few days.
In the rare instance you experience dizziness, faintness, light headedness, mild nausea, chills, sweating or anxiety please notify your practitioner who will attend to you accordingly. These symptoms relate to a phenomenon called “needle shock”, and is considered a harmless transient reaction to acupuncture, usually in the presence of low blood sugar, exhaustion or anxiety. After the treatment, you should feel improved physical and psychological wellbeing, a sense of an energy shift and in some instance tiredness. Pain relief can be expected immediately or in the ensuing days. In some instance symptoms may worsen and is a normal part of the healing process. It is not always possible to predict an outcome of treatment as responses vary depending on the individual, the condition and its severity. If you feel you might be having a reaction or abnormal feelings, please contact the clinic and discuss this with your practitioner who will advise you accordingly. In the unlikely event that you experience shortness of breath, sweating and chest pain after the treatment, then you should contact your general practitioner immediately.
Unusual low risks of acupuncture include, nerve damage and organ puncture, including lung puncture (pneumothorax). Infection is another possible risk, although the clinic uses sterile disposable needles and maintains a clean and safe environment. I understand that while this document describes the major risks of treatment, other side effects and risks may occur.
Confidentiality
Bribie Acupuncture adheres to all relevant State and Commonwealth privacy law requirements. All of the personal and health information we gather from you will be securely stored and will only be disclosed in circumstances where we are required by law to make such disclosures.
I will notify a clinical staff member who is caring for me if I am pregnant. I do not expect the clinical staff to be able to anticipate and explain all possible risks and complications of treatment, and I wish to rely on the clinical staff to exercise judgment during the course of treatment, which the clinical staff thinks at the time, based upon the facts then known, is in my best interest. I understand that results are not guaranteed.
I understand the clinical and administrative staff may review my patient records and lab reports, but all my records will be kept confidential and will not be released without my written consent. By voluntarily signing below, I show that I have read, or have had read to me, the above consent to treatment, have been told about the risks and benefits of acupuncture and other procedures, and have had an 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.