• Disclosure & Consent to Treatment

    Melanie Adrianna Integrative Energy Medicine
  • Education and Experience

    Melanie A. Pawlyszyn earned her Master of Science in Oriental Medicine degree from the Boulder campus of Southwest Acupuncture College in 2020. This four-year program consists of over 3,000 hours of classroom education and over 800 hours of clinical practice. She was certified as a Diplomate of Oriental Medicine by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) in October 2020. This includes certification in Clean Needle Technique and Chinese Herbology. In 2014, Melanie became certified as a Diplomate in Acupressure by the Natural Therapies Certification Board. Melanie's overall training includes adjunctive therapies such as craniosacral therapy, moxibustion, tui na, cupping, injection therapy, and dietary and lifestyle recommendations. She is First Aid and CPR certified by the American Red Cross. Melanie is a licensed acupuncturist in the states of Virgina, North Carolina and Colorado and has never had her license suspended or revoked.

    Contact Information

    soundcreatrix@gmail.com

    Consent to Treatment

    Acupuncture: I understand that acupuncture is performed by the insertion of needles through the skin at certain points on or near the surface of the body in an attempt to treat bodily dysfunction or diseases, to modify or prevent pain perception, and to normalize the body’s physiological functions. I am aware that local bruising, minor bleeding, fainting, pain or discomfort, and the possible aggravation of symptoms existing prior to acupuncture treatment may occur. Unusual and rare risks of acupuncture include spontaneous miscarriage, nerve damage, and organ puncture, including lung puncture (pneumothorax). Infection is another possible risk, although Melanie uses sterile disposable needles and maintains a clean and safe environment.

    Moxibustion, aka 'moxa': This is an herbal substance that is used through several techniques to apply heat to an acupoint in order to increase blood flow and vitality. I understand that moxibustion can result in burning or scarring.

    Tuning Fork Sound Therapy: I understand that I may also be given sound therapy with tuning forks as part of my treatment and that this could result in a detox response or emotional release during or after the session.

    Cupping: I understand that cupping can result in bruising.

    Magnet Therapy: Magnets may be retained topically on specific points on the ear to regulate the nervous system and manage pain in order to support you in the coming days post-treatment. If you experience any pain, itching, or discomfort, please remove the magnets immediately. There are no harmful long-term effects.

    I understand that I may refuse care by any of these modalities at any time and that I may ask my practitioner for a more detailed explanation of any of the above methods. By my signature below, I indicate I have carefully read and understand all of the above information and give my permission and consent to treatment.

  • Client Information

  • Format: (000) 000-0000.
  • Confidentiality and Privacy Agreement

    I, Melanie A. Pawlyszyn, value our relationship and respect your right to privacy. I comply with HIPAA rules and procedures regarding confidentiality. I do not share your medical information without your written consent. If you have specific questions about my privacy guidelines, please ask me.

    Non-Discrimination Commitment 

    I, Melanie A. Pawlyszyn, respect all aspects of people, including age, gender, race, ethnicity, religion/no religion, national origin, language, education, marital status, body size, political affiliation/philosophy, sexual orientation, gender identity/expression or variance, physical and mental ability, social-economic status, genetic information and HIV and veteran status.

    Financial & Cancellation Policies

    Payments are due at the time of booking and prior to your treatment via cash, PayPal, Venmo, or emailed Stripe invoice. I do accept HSA cards. I do not currently process insurance claims; however, you can submit them to your insurance provider. All cancellations within 24 hours of your appointment are non-refundable. Cancellations more than 24 hours prior to your appointment are fully refundable. 

    Thank you for your consideration.

  • Confidential Personal Health History

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  • Please check if you have or have had (in the last three months) any of the following diseases or conditions.

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