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Terms And Conditions

Signing below indicates that you have completed the above form as accurately as possible. You understand it is your responsibility to inform your practitioner of any health changes prior to each treatment. At any time you or your practitioner may refuse treatment. 
We ask that you give us 24 hours notice if you need to cancel or reschedule. You may be charged a “no show” fee of $20 if you fail to cancel your appointment in a timely manner. 
Do not come to the clinic if you have a cold, flu, diarrhea, fever, or uncontrollable sneezing or coughing. We can provide virtual herbal consults and curbside delivery, but you may not get group acupuncture when acutely ill. 
Acupuncture involves the insertion of pre-sterilized, disposable needles into specified points on the body in order to affect a change. In most cases the changes are pleasant and lead to healing. In some cases there may be side effects such as: bruising, discomfort, redness, slight bleeding, fainting, temporary pain/ discomfort/ dizziness or weakness, temporary aggravation of symptoms existing prior to treatment. While this outlines the most commonly occurring adverse effects of treatment, other effects and risks may occur. Please be in communication with your practitioner if you have any concerns. We make no attempt to replace your primary care doctor. We encourage you to see your doctor when necessary and to have routine checkups. 
By signing below you demonstrate your consent to treatment and acknowledge our cancellation policy. You further acknowledge that there is no guarantee regarding the results you may see during the course of your treatment. You are free to withdraw your consent and discontinue treatment at any time.

I have read, understand and accept the Terms & Conditions. The information in this form is correct to the best of my knowledge. *

Melbourne Community Acupuncture

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