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Client details


Treatment Notes


“Acupuncture” means the stimulation of points on the body via the insertion of thin needles. The purpose of acupuncture is to create neuro-physiological reactions in the body and stimulate the body’s own healing processes. In addition, through the normalization of physiological functions, it also often serves in the treatment of certain diseases or dysfunctions of the body. Acupuncture includes the techniques of electro-acupuncture, manual stimulation, cupping, Tui Na massage, and/or moxibustion. Acupuncture may allow for relief of symptoms improving the balance of bodily energies, leading to the prevention of illness, or the elimination of the presenting problems.

Potential risks include slight pain or discomfort at the site of needle insertion, infection, bruises, weakness, numbness, fainting, nausea, and aggravation of problematic systems existing prior to acupuncture treatment. Cupping almost always causes bruising. Rare risks of acupuncture include nerve damage and organ puncture, including lung puncture (pneumothorax). Serious side effects such as these are very rare – less than 1 in 10,000 treatments.

The herbs and nutritional supplements that may be recommended need to be taken according to instruction and all other drugs, herbs and supplements being taken need to be disclosed in order to minimise the risk of unwanted interactions. Some possible side effects of taking herbs are nausea, gas, stomach ache, vomiting, headache, diarrhoea, rashes, hives, and tingling of the tongue. Ki Acupuncture staff must be notified immediately if any of the above-mentioned side effects are experienced.

Some herbs, supplements and acupuncture techniques are inappropriate during pregnancy and must not be used, the treating practitioner must be notified if you are trying to conceive or become pregnant.

To reduce the possibility of infection from acupuncture, all needles are pre-sterilized, one-time-use needles made of surgical stainless steel. After each use they are disposed of as medical waste, needles are never reused.

I understand the clinical and administrative staff may review my patient records, but all my records will be kept confidential and will not be released without my consent. I consent to being contacted by phone, post or email for invoicing, appointment reminders, notifications, education and marketing purposes, and that I can unsubscribe from communications at any time.

I understand that it is my responsibility to inform the practitioner of all current medications, herbs and supplements that I take. In addition I will inform the practitioner of any pace makers, artificial implants, addictions, allergies or other medical conditions I have as they may affect the treatment plan.

By voluntarily checking the box below, I show that I have read the above consent to treatment, have been told about the risks and benefits of acupuncture and other procedures, and will ask any questions I have before the commencement of treatment. 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.

I have read and agree to Ki Acupunctures Privacy Policy, Terms and Conditions, and give my consent for treatment.