Jay Acupuncture and Wellness.
Jay Acupuncture and Wellness.
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“Health is the greatest possession. Contentment is the greatest treasure. Confidence is the greatest friend. Non-being is the greatest joy.” ~ Lao Tzu
Consent to Treatment form:
Consent to Treatment form:
ACUPUNCTURE INFORMED CONSENT TO TREAT I understand that I am the decision maker for my health care. Part of this office’s role is to provide me with information to assist me in making informed choices. This process is often referred to as “informed consent” and involves my understanding and agreement regarding the care recommended, the benefits and risks associated with the care, alternatives, and the potential effect on my health if I choose not to receive the care. Acupuncture is not intended to substitute for diagnosis or treatment by medical doctors or to be used as an alternative to necessary medical care. It is expected that you are under the care of a primary care physician or medical specialist, that pregnant patients are being managed by an appropriate healthcare professional, and that patients seeking adjunctive cancer support are under the care of an oncologist. I hereby request and consent to the performance of acupuncture treatments and other procedures within the scope of the practice of acupuncture on me (or on the patient named below, for whom I am legally responsible) by the acupuncturist indicated below and/or other licensed acupuncturists who now or in the future treat me while employed by, working or associated with, or serving as back-up for the acupuncturist named below, including those working at the clinic or office listed below or any other office or clinic, whether signatories to this form or not. I understand that methods of treatment may include, but are not limited to, acupuncture, moxibustion, cupping, electrical stimulation, Tui-Na (Chinese massage), Chinese herbal medicine, and nutritional counseling. I understand that the herbs may need to be prepared and the teas consumed according to the instructions provided orally and in writing. The herbs may have an unpleasant smell or taste. I will immediately notify a member of the clinical staff of any unanticipated or unpleasant effects associated with the consumption of the herbs. I appreciate that it is not possible to consider every possible complication to care. I have been informed that acupuncture is a generally safe method of treatment, but, as with all types of healthcare interventions, there are some risks to care, including, but not limited to: bruising; numbness or tingling near the needling sites that may last a few days; and dizziness or fainting. Burns and/or scarring are a potential risk of moxibustion and cupping, or when treatment involves the use of heat lamps. Bruising is a common side effect of cupping. Unusual risks of acupuncture include nerve damage and organ puncture, including lung puncture (pneumothorax). Infection is another possible risk, although the clinic uses sterile disposable needles and maintains a clean and safe environment. I understand that while this document describes the major risks of treatment, other side effects and risks may occur. The herbs and nutritional supplements (which are from plant, animal, and mineral sources) that have been recommended are traditionally considered safe in the practice of Chinese Medicine, although some may be toxic in large doses. I understand that some herbs may be inappropriate during pregnancy. I will notify a clinical staff member who is caring for me if I am, or become, pregnant or if I am nursing. Should I become pregnant, I will discontinue all herbs and supplements until I have consulted and received advice from my acupuncturist and/or obstetrician. Some possible side effects of taking herbs are: nausea; gas; stomachache; vomiting; liver or kidney damage; headache; diarrhea; rashes; hives; and tingling of the tongue. While I do not expect the clinical staff to be able to anticipate and explain all possible risks and complications of treatment, I wish to rely on the clinical staff to exercise judgment during the course of treatment which the clinical staff thinks at the time, based upon the facts then known, is in my best interest. I understand that, as with all healthcare approaches, results are not guaranteed, and there is no promise to cure. I understand that I must inform, and continue to fully inform, this office of any medical history, family history, medications, and/or supplements being taken currently (prescription and over-the-counter). I understand the clinical and administrative staff may review my patient records and lab reports, but all my records will be kept confidential and will not be released without my written consent. I understand that there are treatment options available for my condition other than acupuncture procedures. These options may include, but are not limited to: self-administered care, over-the-counter pain relievers, physical measures and rest, medical care with prescription drugs, physical therapy, bracing, injections, and surgery. Lastly, I understand that I have the right to a second opinion and to secure other options about my circumstances and healthcare as I see fit. By voluntarily signing below, I confirm that I have read, or have had read to me, the above 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 agree with the current or future recommendations for care. I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment.
ACUPUNCTURE INFORMED CONSENT TO TREAT I understand that I am the decision maker for my health care. Part of this office’s role is to provide me with information to assist me in making informed choices. This process is often referred to as “informed consent” and involves my understanding and agreement regarding the care recommended, the benefits and risks associated with the care, alternatives, and the potential effect on my health if I choose not to receive the care. Acupuncture is not intended to substitute for diagnosis or treatment by medical doctors or to be used as an alternative to necessary medical care. It is expected that you are under the care of a primary care physician or medical specialist, that pregnant patients are being managed by an appropriate healthcare professional, and that patients seeking adjunctive cancer support are under the care of an oncologist. I hereby request and consent to the performance of acupuncture treatments and other procedures within the scope of the practice of acupuncture on me (or on the patient named below, for whom I am legally responsible) by the acupuncturist indicated below and/or other licensed acupuncturists who now or in the future treat me while employed by, working or associated with, or serving as back-up for the acupuncturist named below, including those working at the clinic or office listed below or any other office or clinic, whether signatories to this form or not. I understand that methods of treatment may include, but are not limited to, acupuncture, moxibustion, cupping, electrical stimulation, Tui-Na (Chinese massage), Chinese herbal medicine, and nutritional counseling. I understand that the herbs may need to be prepared and the teas consumed according to the instructions provided orally and in writing. The herbs may have an unpleasant smell or taste. I will immediately notify a member of the clinical staff of any unanticipated or unpleasant effects associated with the consumption of the herbs. I appreciate that it is not possible to consider every possible complication to care. I have been informed that acupuncture is a generally safe method of treatment, but, as with all types of healthcare interventions, there are some risks to care, including, but not limited to: bruising; numbness or tingling near the needling sites that may last a few days; and dizziness or fainting. Burns and/or scarring are a potential risk of moxibustion and cupping, or when treatment involves the use of heat lamps. Bruising is a common side effect of cupping. Unusual risks of acupuncture include nerve damage and organ puncture, including lung puncture (pneumothorax). Infection is another possible risk, although the clinic uses sterile disposable needles and maintains a clean and safe environment. I understand that while this document describes the major risks of treatment, other side effects and risks may occur. The herbs and nutritional supplements (which are from plant, animal, and mineral sources) that have been recommended are traditionally considered safe in the practice of Chinese Medicine, although some may be toxic in large doses. I understand that some herbs may be inappropriate during pregnancy. I will notify a clinical staff member who is caring for me if I am, or become, pregnant or if I am nursing. Should I become pregnant, I will discontinue all herbs and supplements until I have consulted and received advice from my acupuncturist and/or obstetrician. Some possible side effects of taking herbs are: nausea; gas; stomachache; vomiting; liver or kidney damage; headache; diarrhea; rashes; hives; and tingling of the tongue. While I do not expect the clinical staff to be able to anticipate and explain all possible risks and complications of treatment, I wish to rely on the clinical staff to exercise judgment during the course of treatment which the clinical staff thinks at the time, based upon the facts then known, is in my best interest. I understand that, as with all healthcare approaches, results are not guaranteed, and there is no promise to cure. I understand that I must inform, and continue to fully inform, this office of any medical history, family history, medications, and/or supplements being taken currently (prescription and over-the-counter). I understand the clinical and administrative staff may review my patient records and lab reports, but all my records will be kept confidential and will not be released without my written consent. I understand that there are treatment options available for my condition other than acupuncture procedures. These options may include, but are not limited to: self-administered care, over-the-counter pain relievers, physical measures and rest, medical care with prescription drugs, physical therapy, bracing, injections, and surgery. Lastly, I understand that I have the right to a second opinion and to secure other options about my circumstances and healthcare as I see fit. By voluntarily signing below, I confirm that I have read, or have had read to me, the above 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 agree with the current or future recommendations for care. I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment.
PATIENT NAME:
PATIENT NAME:
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ACUPUNCTURIST NAME:
ACUPUNCTURIST NAME:
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(Date)
(Date)
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PATIENT SIGNATURE X (Or Patient Representative) (Indicate relationship if signing for patient)
PATIENT SIGNATURE X (Or Patient Representative) (Indicate relationship if signing for patient)
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Chinese Herbs Preparation instructions:
Chinese Herbs Preparation instructions:
1. Place one pack of herbs in a clay pot or stainless steel pot (non-aluminium), add about 5 large cups of hot water (or enough to cover herbs for larger packets) and soak for approximately 10- 15 minutes.
1. Place one pack of herbs in a clay pot or stainless steel pot (non-aluminium), add about 5 large cups of hot water (or enough to cover herbs for larger packets) and soak for approximately 10- 15 minutes.
2. Bring the mixture to boil. Then reduce to a low flame allowing the herbs to simmer slowly, with the lid slightly ajar for approximately 20-30 minutes or until reduced to one third.
2. Bring the mixture to boil. Then reduce to a low flame allowing the herbs to simmer slowly, with the lid slightly ajar for approximately 20-30 minutes or until reduced to one third.
(Note : Electric burners tend to adjust the heat automatically. Sometime heat is automatically reduced to too low that is no longer simmering. So, it is a good idea to check the herbs once in a while, ensuring they are still simmering or are not burnt.)
(Note : Electric burners tend to adjust the heat automatically. Sometime heat is automatically reduced to too low that is no longer simmering. So, it is a good idea to check the herbs once in a while, ensuring they are still simmering or are not burnt.)
3. Drain the liquid in a large bowl or container and set aside. Do not discard the herbs in the pot.
3. Drain the liquid in a large bowl or container and set aside. Do not discard the herbs in the pot.
4. Add 5 cups (or enough to cover herbs for larger packets) of boiling water to the herbs already in the pot.
4. Add 5 cups (or enough to cover herbs for larger packets) of boiling water to the herbs already in the pot.
5. Simmer slowly with the lid slightly ajar for approximately 30 minutes or until the liquid is reduced to half.
5. Simmer slowly with the lid slightly ajar for approximately 30 minutes or until the liquid is reduced to half.
6. Drain the liquid into the previous bowl/container. Lightly stir the mixture for a more even concentration. Let it sit for 10 minutes or so, then divide herbal liquid into two cups.
6. Drain the liquid into the previous bowl/container. Lightly stir the mixture for a more even concentration. Let it sit for 10 minutes or so, then divide herbal liquid into two cups.
7. Strain it and drink (slightly warm) 1 cup, 30 min. before meals. 2 Times a day
7. Strain it and drink (slightly warm) 1 cup, 30 min. before meals. 2 Times a day
* If you forget to drink your herbs 30 min before meals, then you can drink the liquid 1 hour after your meal.
* If you forget to drink your herbs 30 min before meals, then you can drink the liquid 1 hour after your meal.
(Note: the other cup can be kept in the fridge, and warm it back up before drinking the next day. Or you can keep the warm liquid in a thermos immediately after cooking, and drink warm the next day.
(Note: the other cup can be kept in the fridge, and warm it back up before drinking the next day. Or you can keep the warm liquid in a thermos immediately after cooking, and drink warm the next day.
Drinking Herbal Decoction
Drinking Herbal Decoction
The herbal decoction doesn’t taste good, for some it tastes really bad !
The herbal decoction doesn’t taste good, for some it tastes really bad !
TIPS :
TIPS :
It is recommended to hold your nose ( we mean it !) when drinking the herbs, and keep holding it until you wash out your mouth with water or eat something small like a biscuit or a piece of fruit. All our herbal packs come with complimentary Chinese plum candies to help you clear the bitter taste in the mouth too.
It is recommended to hold your nose ( we mean it !) when drinking the herbs, and keep holding it until you wash out your mouth with water or eat something small like a biscuit or a piece of fruit. All our herbal packs come with complimentary Chinese plum candies to help you clear the bitter taste in the mouth too.
Don’t force yourself with a larger volumn than you feel comfortable with. You can divide your daily dosage to smaller doses, and drink when whenever you feel comfortable within the same day.
Don’t force yourself with a larger volumn than you feel comfortable with. You can divide your daily dosage to smaller doses, and drink when whenever you feel comfortable within the same day.
Before drinking the herbal liquid, first let the liquid sit for 10-15 minutes, allowing the sediments to settle at the bottom. Don’t stir it up before drinking, just drink the clearer liquid above the sediment.
Before drinking the herbal liquid, first let the liquid sit for 10-15 minutes, allowing the sediments to settle at the bottom. Don’t stir it up before drinking, just drink the clearer liquid above the sediment.
It maybe hard to begin with, you will slowly get used to the taste !
It maybe hard to begin with, you will slowly get used to the taste !
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