Please List Any Medication You Are Taking
Current health habits and symtoms:
I understand that Acupuncture / Chinese Herbal Medicine, dietary therapy and other Traditional Chinese Medicine (TCM) modalities are safe and effective for the prevention and treatment of a wide range of health problems, and for the promotion of general well being. Although Acupuncture / TCM are helpful for many health conditions, I understand that it is not intended to replace any tests or treatments recommended by my physicians. I will continue to take my prescribed medications while I receive alternative treatment modalities at this clinic.
I have informed the TCM Practitioner (R.TCMP) / Acupuncturist (R.Ac) / Registered Nutritionist of all my known physical and emotional conditions, medical conditions and medications, and I will keep the Practitioner updated on any changes. I understand that there shall be no liability on the practitioner’s part due to my forgetting to relay any pertinent information. I realize no claims, promises or guarantees are being made. I understand that medications and social habits may decrease the effects of alternative treatment modalities. I accept full responsibility for the effectiveness of my treatment.
I understand that Acupuncture and related TCM modalities are safe. Occasional bruising (which is normal skin reaction to needle insertion) may occur. Fainting is rare. However, it may happen due to extreme nervousness, hunger or fatigue. I also understand that herbal medicine are generally safe and effective. Occasional abdominal upset, diarrhea and sweating may occur in response to treatment.
The initial Appointment Fee for acupuncture / initial bioenergetic test / cupping or TCM Tuina Massage is $110 for all new patients.
The Appointment fee for food compatibility test, fertility consultation and cancer recovery consultation is $200 +tax each.
The consultation fee for Chinese herbal medicine is $80. Chinese herbs can be purchased at cost plus shipping. There is no refilling fee unless a new herbal medicine prescription is required.
If you are here for an acupuncture treatment or herbal medicine prescription and subsequently request nutritional advice to improve your health condition, please note that a service fee of $35 may be added to your invoice.
Your Private Health Insurance Program generally covers the fees for Acupuncture and nutritional consultation. You'll receive a receipt for the service rendered.
A 2-business-day cancellation policy is in effect. Cancellation and rescheduling request with less than 2-business-day notice may result in a penalty fee of $50. This fee may be added to the subsequent appointment visit unless this is due to an emergency situation.
Please be on time for all your appointment bookings. If you arrive late for your appointment, you may not receive service due to time constraints. The late cancellation fee of $50 may apply to your subsequent visit.
