When performed by a qualified acupuncturist and/or traditional Chinese medicine (TCM) practitioner, treatment involving acupuncture, herbal medicine or any other associated TCM techniques is a safe effective method of treatment for many conditions. There are, however, risks associated with any treatment that we are required to inform you about.
I request and consent to the performance of acupuncture and/or traditional Chinese herbal medicine (TCM) and associated techniques by the practitioner listed below.
I confirm that I will have the opportunity to discuss with the practitioner the nature and purpose of traditional Chinese medicine therapy and associated techniques. I understand that results are not guaranteed.
I understand, and acknowledge that in the practice of TCM, as in all medicine, there are some very slight risks to treatment including, but not limited to muscle & joint soreness, mild bruising, and herb intolerance. I do not expect the TCM practitioner named below to be able to anticipate and explain all of the risks and possible complications. I agree to rely on them exercising their judgment during the course of my treatment in the manner that is in my best interests, based on the facts then known.
Where deemed appropriate I consent to photo/video recording for biomechanical assessment.
I have read the above, and confirm that I will have the opportunity to ask questions. I intend this consent form to cover the entire course of treatment for my present condition, and for any other future condition(s).
I understand that I can withdraw my consent at any time in writing.
Future appointments at this clinic may be required to be block booked to ensure the optimal outcome for your condition, illness or injury.
I consent to receiving appointment reminders (by SMS & email) and other information from time to time regarding the services of Melbourne Osteopathy Sports Injury Centre. I understand that I can opt out of these notifications if requested.
This clinic has a 24 hour cancellation policy that applies to all appointments. Failure to provide 24 hours notice when changing or cancelling appointment times and missed appointments will result in being charged the full appointment fee. It is expected that you will pay for each appointment at the end of your session.
If you are happy with your consult we would appreciate it if you could refer friends and family to our centre.
At the end of your first treatment we request that you complete a patient feedback form.