Acupuncture Consent Form

Client Details:

Emergency Contact:

Treatment

Acupuncture involves the insertion of fine, sterile, single-use needles into specific points on the body. Treatment may also include related therapies such as cupping, moxibustion, gua sha, acupressure, massage or heat therapy. Treatment is tailored to the individual and may change over time.

Benefits & Risks

Acupuncture may help with a range of physical or emotional conditions; results vary and are not guaranteed. Possible side effects include mild bruising or bleeding, temporary soreness, dizziness, fatigue, temporary changes in symptoms, or (rarely) fainting or burns from heat-based therapies. Serious adverse effects are very rare.

Medical Information

I understand that it is my responsibility to disclose all relevant information about my health, including any medical conditions, medications, allergies, pregnancy, bleeding disorders, implanted medical devices, or any other information that may affect my treatment, during my consultation and before receiving treatment.

Confidentiality

My personal and medical information will be handled confidentially in accordance with UK data protection laws (UK GDPR).