This is an informed consent document that has been prepared to help your acupuncturist inform you concerning facial acupuncture treatments, the risks involved, and possible alternatives.
Be advised: this is not a surgical procedure. It is important that you read this information carefully and completely. Initial each page indicating that you have read the page, and sign the consent for facial acupuncture treatments, as proposed by your acupuncturist.
An acupuncture facial treatment involves the insertion of acupuncture needles into fine lines and wrinkles on the face and neck to reduce the visible signs of aging. In Asian medicine, the meridians or pathways of Qi (energy) flow throughout the entire body from the soles of the feet to the face and head. Consequently, a facial acupuncture treatment addresses the entire body constitutionally, and is not merely “cosmetic.”
An acupuncture facial involves the patient in an organic, gradual process that is customized for each individual. It is no way analogous to, or a substitute for, a surgical “face lift.” A treatment session may confine itself solely to facial acupuncture, or it may be used in conjunction with other procedures.
Facial acupuncture can increase facial tone, decrease puffiness around the eyes, as well as bring more firmness to sagging skin, enhance the radiance of the complexion, and flesh out sunken areas. Customarily, fine wrinkles disappear, and deeper ones be reduced. As this treatment is not merely confined to the face, it incorporates the entire body and constitutional issues of health.
Improvement of sagging skin, wrinkles and fatty deposits may be attempted by other treatments or surgery such as a surgical facelift, chemical face peels, or liposuction. Risk and potential complications are associated with these alternative forms of treatment.
Every procedure involves a certain amount of risk and it is important that you understand the risks involved with an acupuncture facial. An individual’s choice to undergo an acupuncture facial is based upon the comparison of the risk to potential benefit.
Although the majority of patients do not experience the following complications, you should discuss each of them with your acupuncturist to make sure you understand the risks, potential complications, and consequences of an acupuncture facial.
There are many variable conditions in addition to risk and potential complications that may influence the long term result from acupuncture facial treatments. Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with an acupuncture facial treatment. Other complications and risks can occur but are even more uncommon. Should complications occur, other treatments may be necessary.
The practice of acupuncture is not an exact science. Although good results are expected, there is no guarantee or warranty, either expressed or implied, on the results that may be obtained.
A full course of Traditional Acupuncture Facial Rejuvenation consists of an initial consultation and 10 sessions. It is highly recommended that time between initial treatments not exceed seven days.
For your first appointment expect to be here for at approximately 1.5 hours. We do an initial consultation that takes approximately 15 - 30 minutes. If you are a new patient, we do an additional intake interview. Future treatments last between 60 - 75 minutes.
The treatments consist of a combination of needling, cupping, Gua Sha, and the use of a special revitalizing serum (also available for purchase). Maintenance treatments are recommended at once per month for 3 months, then every 6 to 12 weeks as desired.
The cost of an acupuncture facial involves several charges for the services provided. The total includes fees charged by your acupuncturist, the cost of acupuncture supplies, and topical preparations.
The initial consultation for current patients is $50; the consultation for new patients is $100 and it includes a thorough intake. The treatment protocol is 10 sessions at $150 each (plus the consultation fee), and is to be prepaid.
Insurance does not cover the costs of Facial Acupuncture or similar treatments.
Informed-consent documents are used to communicate information about the proposed procedure along with disclosure of risks and alternative forms of treatment(s). The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances. However, informed consent documents should not be considered all-inclusive in defining other methods of care and risks encountered. Your acupuncturist may provide you with additional or different information which is based upon all the facts in your particular case and the present state of knowledge within the field of acupuncture. Informed consent documents are not intended to define or serve as the standard of acupuncture. Standards of acupuncture are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.
It is important that you read the above information carefully and have all of your questions answered before signing the following consent.
I consent to the treatment or procedure, and the above listed items (1-4). I am satisfied with the explanation.
Patient Signature (or Person authorized to sign for patient)