My Services

You must be at least 18 years old. Wear loose clothing. I will need access to the skin on your neck, shoulders, abdomen, back, arms up to elbows, and legs up to knees. It’s best if you bring a pair of athletic shorts to wear during your treatment. A light snack before treatment is ok, but do not come to your appointment with a full stomach. Please avoid alcohol and pain medication for at least 6 hours prior to your appointment, since I will be pressing on your body to find pain and tenderness, and painkillers can prevent an accurate exam. Since I need to feel deep muscles, I can not treat you if your weight is over 250 lbs for men or over 200 lbs for women.

Payment is cash, check, or credit card only. Medical insurance is not accepted or filed.

Inner Wellness Acupuncture LLC Patient Informed Acupuncture Consent Form

(Signature required before the procedure is to begin)

PROCEDURES: Acupuncture, Trigger Point Needling, and Dry Needling

By Signing Below, I voluntarily consent to be treated for a series of treatments with acupuncture, trigger point needling, and dry needling.

ACUPUNCTURE PROCEDURE:

I understand that acupuncture includes a variety of techniques and diagnostic methods that includes palpation of different regions of my body, needle insertion, and exposure to an infrared heat lamp. I will be asked certain health-related questions. The pulse at my wrist, and the muscles and skin of my abdomen, pelvis, neck, back, and other body parts will be pressed. Based on this examination, certain acupuncture points on my body will be selected for needle insertion. The acupuncture needles used are all sterile, single-use, stainless steel needles. The needles will be placed in the selected points at a depth that will be through the superficial layer of skin and into the soft tissue and muscles below.

RISKS AND DISCOMFORTS:

The likelihood of significant risks or complications from this procedure/treatment are rare, and include, but are not limited to: fainting, bleeding, bruising, pain, superficial burns of the skin, infection, aggravation of existing symptoms, tingling or nerve sensations, drowsiness which may require a delay in driving home from this facility or arranging alternative transportation, and pneumothorax (the puncturing of the lung by a needle, which may require admission to an emergency department of a hospital for placement of a chest tube to re-inflate a collapsed lung)- reported incidence of 1 in 1 million. Other unexpected risks or complications not discussed may occur and no guarantees or promises can be made concerning the results of any procedure(s) or treatment(s).

ALTERNATIVE PROCEDURES:

As a patient, I am free to pursue alternative procedures for my condition that I might consider instead of participating in acupuncture treatment. If I have more detailed questions about alternative standard techniques, an appropriate referral can be made by my primary care physician. Acupuncture does not replace standard medical care, and by signing this form, I agree that acupuncture is a complementary form of healthcare, and I take full responsibility for seeking standard medical care from my primary physician for any known or unknown medical condition that I may have. I understand that acupuncture treatments, like many other medical treatments, will not always succeed in alleviating my symptoms, and no guarantees have been made as to the results that may be obtained from acupuncture. By signing below, I show that I have read, or have had read to me, the above consent to acupuncture treatment, have been informed about the risks and benefits of such treatment and other related 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 conditions for which I seek treatment with acupuncture.

For optimal results of your acupuncture session:

Rest and take it easy for the day. You don’t need to sleep all day, but avoid any strenuous exercise or activities, just relax, and enjoy the continued healing. What’s more, the rest helps to restore clients’ physical and emotional well-being.

Eat well, in order to maximize the potential benefits, clients should eat healthy, non-processed foods that are rich in vitamins and antioxidants. Avoid alcohol, junk foods, and refined sugars.

Drink drink drink plenty of water to flush out any toxins that may have been released.