COVID-19 Policy
This document contains important information about our decision (yours and mine) to resume in-person services in light of the COVID-19 public health crisis. We have agreed to meet in person for our sessions. However, if there is a resurgence of the pandemic or if other health concerns arise, we may require that the sessions are paused until it is safe to continue
Your Responsibility to Minimize Your Exposure:
To obtain services in person, you agree to take certain precautions which will help keep everyone (you, me, our families, all staff, and other patients) safer from exposure, sickness and possible death. Please adhere to the following safe guards.
Acupuncture Treatment Consent
I, the undersigned, do hereby give my voluntary consent for the administration of medical acupuncture techniques and other relevant Chinese medical therapies.
Acupuncture is a medical treatment performed by the insertion of special sterilized fine needles with or without the application of electrical stimulation through the skin into the underlying tissues and muscles at specific points on the body for the purpose of alleviating pain and treating other clinical conditions.
Ancillary techniques of acupuncture may include one or more of the following:
I state that I do not have the following conditions:
• Pregnancy
• Bleeding disorders
• Pacemaker
• Local infections
• Anticoagulants
If I have any of the above conditions, it is my responsibility to inform your practitioner.
Financial Policy
Broken appointments represent a cost to us, to you and to other patients who could have been seen in the time set aside for you. Cancellations are requested at least 24 hours prior to the appointment. In keeping with industry standards, we reserve the right to charge the credit card on file for missed or late-cancelled appointments.
Notice of Privacy Practices
How I may use your information:
This document contains important information about our decision (yours and mine) to resume in-person services in light of the COVID-19 public health crisis. We have agreed to meet in person for our sessions. However, if there is a resurgence of the pandemic or if other health concerns arise, we may require that the sessions are paused until it is safe to continue
Your Responsibility to Minimize Your Exposure:
To obtain services in person, you agree to take certain precautions which will help keep everyone (you, me, our families, all staff, and other patients) safer from exposure, sickness and possible death. Please adhere to the following safe guards.
- You will only keep your in-person appointment if you are symptom free. If you experience fever, chills, cough, loss of taste or smell, breathing difficulties, flu-like symptoms such as fatigue, muscle weakness, headache, nausea, vomiting, sore throat, or nasal congestion, you will let us know, and we will reschedule your appointment for a later date. Cancellation fees will be waived in these situations.
- You will wait in your car or outside [or in a designated safer waiting area] until no earlier than 5 minutes before our appointment time.
- You will wash your hands or use alcohol-based hand sanitizer when you enter the building.
- You will wear a mask in all areas of the office.
- You will take steps between appointments to minimize your exposure to COVID.
- If you have a job that exposes you to other people who are infected, you will immediately let us know.
- If a resident of your home tests positive for the infection, you will immediately let us know and we will reschedule your appointment after proper exposure protocol has been followed.
- Staff will reschedule appointments if they are experiencing any COVID 19 symptoms.
- Staff is periodically tested for COVID 19.
- HEPA air filtration system is running 24/7.
- We have increased sanitization of surfaces and spaces in between each appointment. This includes face rest, massage table, door handles, table surfaces, pens, clip boards, seating, bathrooms, and light switches.
- Window is cracked for ventilation when possible.
- Contactless payment is implemented.
- Professional laundry service.
- Masks are required for both patient and practitioner at all times. No exceptions.
- Hand sanitizer and disinfecting wipes are readily available.
- Appointments are scheduled with ample time in between to implement sanitizing protocols as well as to keep one client at a time in the office.
- Patients are monitored for fever.
Acupuncture Treatment Consent
I, the undersigned, do hereby give my voluntary consent for the administration of medical acupuncture techniques and other relevant Chinese medical therapies.
Acupuncture is a medical treatment performed by the insertion of special sterilized fine needles with or without the application of electrical stimulation through the skin into the underlying tissues and muscles at specific points on the body for the purpose of alleviating pain and treating other clinical conditions.
Ancillary techniques of acupuncture may include one or more of the following:
- Moxibustion -whereby herbal heat is applied to specific acupuncture points
- Cupping- whereby suction cups are applied to specific points on the body or motion suction cups
- Electro-acupuncture- whereby the needles are electrically stimulating at various high frequencies to cause relaxation of the muscles and analgesia of the area of pain involved.
I state that I do not have the following conditions:
• Pregnancy
• Bleeding disorders
• Pacemaker
• Local infections
• Anticoagulants
If I have any of the above conditions, it is my responsibility to inform your practitioner.
Financial Policy
Broken appointments represent a cost to us, to you and to other patients who could have been seen in the time set aside for you. Cancellations are requested at least 24 hours prior to the appointment. In keeping with industry standards, we reserve the right to charge the credit card on file for missed or late-cancelled appointments.
Notice of Privacy Practices
How I may use your information:
- For treatment purposes.
- For billing services.
- For office operations such as text or email communications.
- For persons involved in your care or payment for your care - We may share your health data with a family member, a close friend, or other person that you given permission to be involved with your health care.
- As required by federal, state, or local law.
- If child abuse or neglect is suspected.
- Law enforcement (to help law enforcement officials respond to criminal activities).
- To avert a threat to an individual or to public health safety as required by law.
- Right to inspect your health record and to receive a copy of your health record upon request.
- Right to amend information in your health record you believe is inaccurate or incomplete.
- Right to know to whom we have disclosed your health information.
- Right to ask for limits on the health information data we give out about you.