Contact MCA

First

Consent for Services & Cancellation Policy

Treatment at Maine Center for Acupuncture is conducted only after new patients read and agree to our consent for services and cancellation policy.

Consent to Services:  

I understand that acupuncture serves individuals with a wide range of complaints including both acute and chronic healthcare issues. I understand that I may be treated with one or more of the following: the insertion of needles, and Zero Balancing.

I understand that acupuncture and the other techniques listed above may result in certain side effects, including local bruising, slight bleeding, fainting, temporary pain and discomfort, temporary discoloration of the skin, and temporary aggravation of symptoms existing prior to treatment.

I know that each person is unique and has ultimate responsibility for his/her own healthcare. I acknowledge that I have not received any guarantees or promises as to the results or success that will be obtained from the services provided.

I understand that infectious diseases are carried through the air, through physical contact, and through bodily fluids. Maine Center for Acupuncture practitioners follow universally prescribed precautions and procedures (such as clean needle technique and hand washing) to prevent the spread of infectious disease.

I understand that it is my responsibility as a patient to inform my practitioner about all aspects of my health and that, as service progresses, to inform my practitioner of changes that occur. If I experience any pain, discomfort, or possible adverse side effects, it is my responsibility to immediately notify my practitioner.

I recognize that an acupuncturist is not a substitute for a medical doctor, and will not suggest that I discontinue medical treatment. I am free to consult a medical doctor or any other licensed practitioner at any time. I understand also that if there is an emergency, or a worsening of my health condition, or if a new ailment or condition arises, that I should consult a licensed physician.

Cancellation Policy

I have been informed of the fees for service, and I understand that payment is due at the time of treatment. If I cancel an appointment with less than 24 hours notice, I must pay a $30.00 late cancellation fee for a “Follow-up Acupuncture” appointment, or $50.00 for an “Acu + 10” appointment.