New Patient Registration


Patient Treatment Agreement

Dekang Medical Clinic is committed to providing all patients with exceptional service and care. We appreciate your participation and support of our academic programs

Consent to Treatment

You, the Patient, hereby request and consent to the performance of Acupuncture, Traditional Chinese Medicine (TCM ), Osteopaths treatments and other procedures on you (or on the patient named below, for whom you are legally responsible) by the practitioner who now or in the future treat you while employed by, working or associated with or serving as back-up for Dekang Medical Clinic, including those working at the clinic or office listed on Dekang Medical website.

You, the Patient, understand that methods of treatment may include, but are not limited to, acupuncture, moxibustion, cupping, electrical stimulation, Tui-Na (Chinese massage), Chinese herbal medicine, Osteopaths and nutritional counselling.

Side Effects

You, the Patient, understand that the herbs may need to be prepared and the teas consumed according to the instructions provided orally and in writing. The herbs may be an unpleasant smell or taste. You, the Patient, will immediately notify a member of the clinical staff of any unanticipated or unpleasant effects associated with the consumption of the herbs.

You, the Patient, have been informed that acupuncture is a generally safe method of treatment, but that it may have some side effects, including bruising, numbness or tingling near the needling sites that may last a few days, and dizziness or fainting. Burns and/or scarring are a potential risk of moxibustion and cupping, or when treatment involves the use of heat lamps. Bruising is a common side effect of cupping.

You, the Patient, understand that while this document describes the major risks of treatment, other side effects and risks may occur. The herbs and nutritional supplements (which are from plant, animal and mineral sources) that have been recommended are traditionally considered safe in the practice of Chinese Medicine, although some may be toxic in large doses. You, the Patient, understand that some herbs may be inappropriate during pregnancy. Some possible side effects of taking herbs are nausea, gas, stomach-ache, vomiting, headache, diarrhea, rashes, hives, and tingling of the tongue. You, the Patient, will notify a clinical staff member who is caring for you if you are or become pregnant.

You, the Patient, do not expect the clinical staff to be able to anticipate and explain all possible risks and complications of treatment, and you, the Patient, wish to rely on the clinical staff to exercise judgment during the course of treatment which the clinical staff thinks at the time, based upon the facts then known is in your best interest. You, the Patient, understand that results are not guaranteed.

Privacy and Disclosure

You, the Patient, have received Dekang Medical Clinic’s Notice of Privacy policy and consents to the use and disclosure of you or the patient's health information to carry out treatment, payment activities, and health care operations. In order to assist in the improvement of medical care through research, study, and teaching, You, the Patient, authorizes representatives of Dekang Medical to use all or part of your record including written records, radiographs, photographs, videotapes, and laboratory reports in photographic or written form for teaching and research purposes which may lead to publication in scientific journals so long as you are not identified by name in connection therewith. This may also involve news releases to newspapers and broadcast media.You, the Patient, have the right to revoke consent at any time by written notice. However, Dekang Medical Clinic may decline to treat you if this consent is revoked.

Payment and Refund, Late Cancellation/No-Show Policy

In all cases, You, the Patient, agree to the following policies:

  • Payment is due no later than when services are rendered, and there is no refund for diagnosis, treatment or any other medical service.

  • You, the Patient, agree that if you need to cancel or cannot attend a medical or counseling appointment, you must call to cancel by 4:00 p.m. the business day before your appointment. If you fail to cancel by the aforementioned time, A Missed Appointment Charge of $20 will be applied to your account. If you just don’t show up at your appointment without informing the clinic before the scheduled visiting time, a full payment will be applied to your account.

Exemption of Liability

You, the Patient, have fully read and understood Dekang Medical Clinic’s policy, and have been informed with the possible risks of getting above mentioned treatments. You, the Patient, absolve Dekang Medical Clinic, all practitioners, apprentices, and clinic staff if you experience any unexpected effect results of the treatment due any reason. You further agree to not commence lawsuit of any kind against all parties mentioned.


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