I, , do give consent to acupuncture treatments and other procedures associated with Traditional Chinese Medicine by Dr. Paul F. Ryan, DACM, L.Ac., and/or any guest Licensed Acupuncturist, tutorial students, or clinic assistants working under his supervision.
I understand that methods of treatment may include, but are not limited to acupuncture, moxibustion, cupping, scraping (gua sha), electric stimulation, massage, stretching, exercises, herbal medicine, and/or nutritional/dietary counseling. Instruction and guidance in non-religious mindfulness meditation is offered when deemed appropriate.
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I have been informed that acupuncture is a safe method of treatment, but that it may have side effects, including, but not limited to bruising, numbness, or tingling near the needling sites that may last a few days, and dizziness or fainting. Bruising is a common side effect of cupping and scraping. Unusual risks of acupuncture include spontaneous miscarriage, nerve damage, and organ puncture, including lung puncture (pneumothorax). Infection is another possible risk, although the clinic uses sterile needles and maintains a clean and safe environment. Burns and/or scarring are a potential risk of moxibustion. I understand that while this document describes major risks of treatment, other unanticipated side effects may occur. I do not expect the Licensed Acupuncturist to be able to anticipate a possible complications from treatment, but I do wish to rely on the Licensed Acupuncturist to exercise judgment during the course of the procedure which the Licensed Acupuncturist feels at the time, based upon the facts then known, is in my best interests.
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Chinese and Western herbs (which are from plant, animal, and mineral sources) are traditionally considered safe in the practice of Chinese medicine, although some may be toxic in large doses. New York State recognize the use of herbs, or oriental/herbal medicine, as part of the profession of acupuncture. The effects of herbal medicine are generally mild and comfortable. However, sometimes the desired effects are difficult to distinguish from adverse effects. Some desired effects that can be confused with side effects are profuse sweating, nausea and vomiting, an increase in pain or tingling in the body and skin disease eruptions (e.g., rashes, hives). The possibility of experiencing these desired effect will be explained and predicted whenever possible. Examples of clear side effects are tingling of the tongue, and spontaneous miscarriage.
I understand that recommended herbs may need to be prepared and the tea consumed according to the instructions provided orally and in writing. The herbs may have an unpleasant taste or smell. I will immediately notify Paul or a member of the clinic staff of any unpleasant effects associated with the consumption of the herbal teas or products.
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I will notify my practitioner if I am or become pregnant.
COVID-19 CARE
There is publicly available information in peer reviewed journals via PubMed on the use of Chinese herbal medicine for COVID-19 prevention, treatment and convalescence (email appt@ewiw.org for links to and PDF versions of the articles, one link below). One such article indicates that Chinese herbal medicine became standard practice in China and it was used in 85% all cases. The authors evaluate the results of usage as decreasing severity of symptoms, hospitalization rates, use of ventilators and improved recovery. The FDA and CDC do not recognize or recommend Chinese herbal medicine as a treatment for COVID-19 at any stage of the disease process.
PubMed Article
I am aware that neither the CDC or FDA recognize or recommend Chinese herbal medicine as a treatment for COVID-19 at any stage of the disease or its recovery. I take full responsibility for all treatment outcomes should I choose to use Chinese herbal medicine in my treatment of this disease.
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It is agreed with regard to medical care and services, the attending Licensed Acupuncturist will provide services to the patient and to the best of his skill and knowledge, medical care appropriate to the situation. The patient will cooperate fully with the Licensed Acupuncturist by following his instructions and adhering to such treatment plan or course of action as may be set forth and agreed. It is the patient’s right to accept or reject any diagnostic procedure, or any part of it, before or during the diagnosis or treatment.
By voluntarily signing below, I show that I have read, or have had read to me, this consent to treatment, have been told about the risks and benefits of acupuncture and other procedures, and have had an opportunity to ask questions. I intend this consent form to cover the entire course of treatment for my present condition and for any future conditions for which I seek treatment at this clinic.