Medical Acupuncture Consent Form

Medical acupuncture involves insertion of fine, solid stainless steel acupuncture needles into the skin

at specific points on the body to achieve a therapeutic effect. No drugs are injected; the needles

alone create the beneficial effects of acupuncture.

Medical acupuncture is a valuable treatment for general health, injury rehabilitation and chronic

pain. Like any medical procedure, there are possible complications:

• Anytime a needle is used there is a risk of infection. New, disposable sterile needles are used each

time so infection is rare.

• A needle may be placed inadvertently in a small blood vessel and there is risk of bruising. This is

primarily a cosmetic complication but can sometimes cause tenderness for a few days to that site.

• A needle may also be inadvertently placed in a nerve, which may case paraesthesias (a prickling

sensation). This may continue for days then resolve spontaneously.

• Due to heightened sensitivity of the nervous system with medical acupuncture, one might feel

faint or dizzy during treatment. Although this feeling is transient, fainting is possible and fatigue

may accompany or follow the treatment.

Fortunately none of these complications are fatal and all are readily reversible. While these

complications are rare in occurrence, they are real and must be considered prior to consenting to the

treatment.

I have read the above, understand the risks involved, and consent to medical acupuncture treatment

from Dr. Alex Chan, ND.