enterSTELLAR
Please read and sign
Informed Consent for Acupuncture Treatment
Acupuncture Center of Minneapolis · 612-822-2925 · acupuncturecenterofminneapolis.com
I understand that the scope of practice of acupuncture according to Minnesota State Law includes, but is not limited to, acupuncture, defined as the insertion of sterile, single use, disposable acupuncture needles through the skin. Community acupuncture in a sound bath setting creates a wellness synergy where the vibrations of sound act like carrier waves to support the physical and energetic balance of acupuncture.
Benefits in this setting
- Increased alpha and theta brainwave states (deeper relaxation)
- Parasympathetic nervous system stimulation, cortisol suppression, and vascular relaxation (deactivating stress pathways)
- Endorphin production, muscular release, and pain pathway competition (pain and tension relief)
- An "antenna effect," where the needles act as conductors, transmitting sound vibrations into tissue, unblocking Qi, and reaching the deeper channels of the body (energetic and cellular optimization)
Risks
Acupuncture needles inserted into the skin can cause pain or discomfort, bruising, slight bleeding at the insertion site, infection, a feeling of weakness, fainting, or nausea. Risk of fainting, weakness, and nausea are increased with an empty stomach and with the use of alcohol or other recreational drugs.
I hereby acknowledge that I have been advised of the benefits and risks of acupuncture. I understand these risks and benefits and consent to accept treatment using these methods. I agree to release the named acupuncturists, Acupuncture Center of Minneapolis, enterSTELLAR, and all associated personnel from all legal responsibility for practices done here.
Acupuncture at this event is provided by licensed acupuncturists of Acupuncture Center of Minneapolis. Amelia Bierschbach, DAcCHM, L.Ac. completed a Doctoral degree in Acupuncture and Chinese Herbal Medicine, is licensed with the Minnesota Board of Medical Practice, and is board certified with the National Certification Board for Acupuncture and Herbal Medicine. Matt Bierschbach, MSTCM Ca, L.Ac. trained at the Pacific College of Oriental Medicine and the American College of Traditional Medicine, and practices Classical Chinese Medicine.