PATIENT RECORD
with Dr Li Practice
Patient Declaration
I declare that the information above is true to the best of my knowledge and I give my full consent to the consultation and the related treatment under the instruction of the professional Chinese medicine consultant at the practice.

I understand that the acupuncture is carried out under hygienic conditions with single use needles and that no form of anaesthetic will be used in the procedure, I understand that acupuncture may cause bruising, localised swelling, I will follow the aftercare procedure as explained.

I understand that I am strongly requested to follow the instruction for the professional purpose when having Course of Treatment and any prepared raw herbs will not be Considered as refundable.
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