Consent for Acupuncture
Patient Information and Consent Form
Please read this information and ask your doctor if there is anything concerning you or is there anything you do not understand
You have shown interest to be treated with medical acupuncture along with adjuvant therapy of low level laser therapy. This will involve acupuncture needles or laser equipment or both applied on your body depending on the treatment plan your practitioner will explain in advance. You will be offered chaperon on request, please ask staff/Dr if you need one. You will be expected to have an appropriate exposure of the body parts / joints under treatment. And appropriate joint movement will be done by clinical staff/doctor – Please inform if you need special assistance/ privacy. A gown/clothing sheet will be available for your privacy. You will be offered chaperon on request, please ask staff/Dr if you need one at every consultation. You will be expected to have an appropriate exposure of the body parts / joints under treatment. Please ask clinical staff/ doctor if you have any confusion about any step. All steps will be taken to make you comfortable. You will also be expected to have nursing staff helping the doctors in your management – please inform the doctor if you are not comfortable with this.
Acupuncture: It is a form of alternative therapy where few needles can be inserted or a pointed laser will be applied. It is medically considered safe and the side effects are minimal 1/10,000 treatments
Side Effects: Needles> minor bleed/bruising, sharp needle feeling. Laser> no bleed/no pain
Other General> flare of exiting conditions, drowsiness, fainting, tiredness- less than 3 % patients suffers that and mostly self-limiting
Press needles: Press needles on external ears can be left for 5-7 days if needed – They have small tiny needles with waster proof (only shower-no bath or swimming)bandaid. Risk of infection – swelling or bleeding from ear cartilage. They should be taken out asap if any discomfort or swelling – redness – pain or temperature and doctor should be consulted. They are not MRI safe and should be takn out before any imagng investigations epecially MRI.
Laser Therapy: It is an adjuvant therapy offered to patient where inflamed joints, nerves and tendons/ muscles has to be treated. Considered generally free of side effects but if happen, last 1-2 days mostly on initial sessions
Side effects: Flare up of exiting pain/ condition, warmth, tiredness, numbness feeling, photosensitive reactions. These are generally self-limiting in 1-2 days and mostly on initial sessions
Precautions: Please advise your doctor if you have any of the mentioned issues. 1. Fits/ faints/ funny Turns. 2. Pacemaker or Electrical Implants. 3. Bleeding Disorder/ Cancer. 4. Any blood things medications. 4. Any photo sensitive medications. 5. Open Wounds 6. Existing infections or risk of infection. 7. Pregnancy
General Facts: The above therapy is done by trained practitioners and are valid means of treatment in the field of medicine for variety of illnesses but in no means a replacement of standard medical treatment. It is considered a valid adjuvant treatment to help treating multiple medical conditions. If you have any specific question, please ask the doctor.
Treatment Procedure: It is generally accepted that a fresh injury will need few treatments and a long term illness will take longer to respond. Generally, we expect response building by 3-4 sessions and a good relief by 10-12 sessions. The session is recommended ideally 2 times a week but can be done once a week depending on doctor advice. As the treatment start responding, a space out is done in treatment session frequency. A maintenance treatment may be required for certain recurring long term conditions. The doctor will be able to explain that to you depending on your medical condition as above is a general guideline.
Statement of consent:
I confirm that I have read and understood the above information and asked if there are any questions not answered above and satisfied with the answers and consent for the treatment and can withdraw from treatment any time
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Date of Birth
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