Patient Information 个人信息

Medical History 医疗历史

Consent Form 同意书

I consent to undergo acupuncture treatment, which involves the insertion of sterile, single-use needles. I understand that while acupuncture is generally safe, potential side effects include bruising, minor bleeding, dizziness, pain, discomfort, or a temporary worsening of my symptoms. No specific results are guaranteed.

Pregnancy: I will inform my acupuncturist if I am pregnant, trying to become pregnant, or become pregnant, so that appropriate points can be selected.

I have been informed about the treatment's benefits, risks, alternatives, and potential outcomes. All my questions have been answered to my satisfaction. I am free to stop treatment at any time and I voluntarily consent to this procedure.

本人同意接受针灸治疗。该治疗通过刺入无菌、一次性使用的针灸针进行。 本人理解针灸通常是安全的，但可能存在副作用，包括但不限于：局部淤青、轻微出血、头晕、昏厥、疼痛或不适，以及原有症状可能暂时加重。治疗的效果无法保证。

妊娠告知： 如果本人已怀孕、正在备孕或在治疗期间怀孕，会立即告知针灸师，以便选用安全的穴位。

本人已获知并理解本次治疗的目的、预期效果、潜在风险、弊端、其他治疗方案（包括不治疗）等相关信息。我已有充分机会提出疑问，并得到了满意的解答。我随时可以停止治疗，并在此自愿同意接受本次针灸治疗。