Traditional Chinese Medicine

I hereby request and consent to receive Traditional Chinese Medicine (mentioned as TCM hereinafter) treatments including acupuncture, herbal medicine, Tuina massage, and other related modalities within the scope of practice of TCM practitioners and Acupuncturists performed in Mai Medical Health Centre.

 

I understand that, as with all health care, while rare, there may be some risks to treatment, including;

  • With acupuncture:
    • Occasional bruising, post-needling sensation, fainting, miner bleeding, blistering, nausea, infection and shock.
    • Possible reasons for these symptoms are nervousness, hunger, extreme tiredness, muscle tension, or moving of the body after needling
  • With herbal medicine:
    • Risk of reactions to treatment including nausea, vomiting, dizziness, headaches, malaise or general worsening of symptoms
    • Unknown interactions between western medications and Chinese herbal medicines
  • Other modalities:
    • Risks relevant to treatment such as bruising or bleeding

I also understand that transitions in healing (known as healing crisis) may also produce temporary periods of discomforts including emotional upset, fatigue, malaise, headaches, dizziness, rashes or breakouts, nausea, vomiting or general worsening of symptoms.

 

TCM treatments in general are safe and effective for the prevention and treatment of a wide range of health conditions and for the promotion of general well-being. However, it is not intended to replace tests or treatments recommended by your physicians.

 

I acknowledge that the above treatments and all their ramifications have been fully explained to me and I do not expect the practitioners to be able to anticipate and explain all possible risks and complications. I also absolve the clinic and its practitioners if I experience from any unexpected results of the treatment. I further agree to not commence lawsuit of any kind against all parties mentioned.

 

Cancellation Policy

The clinic requires 24 hours notice when cancelling an appointment. Please be aware that a fee of $25 will be applied for late cancellation or missed appointment.

 

Cancellation Agreement

I understand that I am responsible for payment in full for appointments that are missed without 24 hours notice (1 business day).

Personal Information

 

Benefits Info

 

 

 

Past Traditional Chinese Medicine History

 

Medical History

 

General Health Information

Headache

 

Urination and Bowel Movements

 

Defecation & Bowel Movement

 

Emotions and Stress

Stress

Energy

 

Female Condition

Menstruation

Leucorrhea

 

Male Conditions

 

Life Style