Auricular Acupuncture – Service Agreement

By enrolling in Auricular Acupuncture at White Oak Medicine, I, the participant, agree to the following terms:

Guided by a Medical Professional

I understand that Auricular Acupuncture is offered as part of a holistic wellness practice at White Oak Medicine, guided by Veronica Johnson, FNP-C, a licensed medical provider with expertise in integrative and functional medicine. This treatment focuses on stimulating specific points on the ear to support my physical, mental, and emotional well-being, and is not medically monitored, nor is it intended as a replacement for medical treatment or professional care for acute medical conditions, and it is not intended to diagnose or treat disease.

Disclosure of Medical Risks

I acknowledge that it is my responsibility to disclose any medical conditions, injuries, or concerns that may affect my ability to safely participate in Auricular Acupuncture. This includes, but is not limited to, allergies to metals, infections, heart conditions, pregnancy, blood disorders, or any other medical or mental health conditions. I agree to inform the instructor, Veronica Johnson, FNP-C, in writing prior to treatment about any such conditions. Failure to disclose relevant medical information may increase the risk of adverse effects, for which I, the participant, will be solely responsible.

Assumption of Risk

I understand that there are inherent risks with acupuncture, including, but not limited to, soreness, bruising, dizziness, or fainting. While rare, there are potential risks of infection or other complications from needling, including temporary worsening of symptoms or reactions during or after treatment. I acknowledge that I am assuming full responsibility for these risks associated with Auricular Acupuncture, including any medical complications that may arise.

Right to Refuse Participation

I understand that I have the right to refuse or discontinue participation in any part of the Auricular Acupuncture treatment if I experience discomfort, pain, or other adverse reactions. If I choose to stop the treatment, I will inform the practitioner immediately.

Liability Waiver

I hereby release White Oak Medicine, Veronica Johnson, FNP-C, and any affiliated practitioners from any and all liability, claims, or causes of action arising out of or related to my participation in Auricular Acupuncture treatments.

Acknowledgment and Consent

By completing the payment and participating in Auricular Acupuncture, I acknowledge that I have read, understood, and agree to the terms of this agreement. I give my consent to receive Auricular Acupuncture treatment with full awareness of the associated risks and responsibilities.