What is a acupuncture informed consent?
Patients are often curious about acupuncture and a little nervous about needles. A consent form that explains exactly what happens, what it feels like and what can go wrong, in plain language, puts them at ease and gives you a clear record of informed consent.
This form records the reason for treatment and explains how acupuncture works and what it usually feels like. It commits to sterile, single-use needles opened in front of the patient. It sets out common, less common and rare risks, from bruising and fainting to the rare punctured lung, with extra notes when cupping or moxibustion are used. The patient discloses conditions such as bleeding disorders, blood thinners, pacemakers or epilepsy, and pregnancy or trying to conceive. The form also covers what to do during treatment, the right to stop at any time, confidentiality, and consent for later treatments.
- Best for
- Acupuncturists, TCM clinics, physiotherapists offering dry needling
- Signed by
- The patient and the practitioner
- Covers
- Risks, single-use needles, health and pregnancy, cupping and moxibustion
- Length
- 2 pages
When to use a acupuncture informed consent
- A new patient's first acupuncture appointment
- Acupuncture for headaches, back pain or stress
- Fertility or pregnancy support, with pregnancy recorded
- Clinics that also offer cupping or electroacupuncture
- Multidisciplinary clinics adding acupuncture to physiotherapy
What you fill in
8 blanks, then the name and email of each person who signs: patient, practitioner.
1 The practitioner
- Clinic name*
- Practitioner's name and qualification*
2 The patient
- Patient's name*
- Date of birth
- Reason for treatment*
3 Health
- Health conditions and medication
- Pregnancy* The patient is not pregnant and is not trying to conceive. · The patient is pregnant or may be pregnant. · The patient is trying to conceive.
4 Treatment
- Related methods that may be used (optional)
5 Who signs
- Patient signature and date · An adult patient. For a minor, a parent or guardian should sign.
- Practitioner signature and date, job title
What the acupuncture informed consent covers
- Reason for treatment
- What acupuncture involves
- Risks
- My health
- During treatment
- Records
- Consent
Using the acupuncture informed consent, step by step
1 Clinic and patient
Your clinic name fills in from your account. Add your name and qualification, the patient's name and date of birth, and their reason for treatment.
2 Health
Record relevant conditions and medicines, or leave it empty for the patient to confirm there are none. Choose the pregnancy statement that applies.
3 Methods
If you use cupping, moxibustion or electroacupuncture, list them, and the form adds their specific risks.
4 Sign before the first treatment
Send it with the booking so the patient can read it at home. They sign on their phone, you countersign, and it's filed in your FileIt vault.
Tips before you send it
- Ask about blood thinners and implants every visit, not just the first.
- Suggest a light meal before treatment to reduce the chance of fainting.
- Follow your professional body's guidance on points to avoid in pregnancy.
- Ask patients to update the form if they start new medicines or become pregnant.
Sign it online in minutes
- Fill in the blanks. Names, dates and amounts go straight into the agreement — the preview shows exactly where.
- Name who signs. Tick “This is me” for your own part. FileIt builds the PDF with every signature, date box on the right line, and you can check or move anything before sending.
- Send it. Each signer gets a secure link and signs from any device — no account needed. The signed PDF, with an audit trail and a Certificate of Completion, is filed in your vault and emailed to everyone.
Acupuncture informed consent: frequently asked questions
Does the form mention single-use needles?
Yes. It says sterile, single-use needles are opened in front of the patient, disposed of straight after use and never reused.
What risks does it list?
Common: bruising, spots of bleeding, soreness, tiredness. Less common: feeling faint. Rare: infection, a broken needle, nerve irritation or a punctured lung. Cupping marks and heat-treatment burns appear only when those methods are listed.
Can a patient stop mid-treatment?
Yes. They can ask for a needle to come out or stop the treatment at any time without giving a reason.
Does it cover future treatments?
It covers later treatments for the same reason until the patient withdraws consent. Use a new form for a different problem or after a significant health change.