Guo An Tang TCM Clinic

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Health Declaration

TCM SG Health Declaration&Consent Form 

国安堂健康声明&治疗同意书

Please take a minute to fill in the following info















    I hereby request and consent to the performance of Acupuncture and other related procedures by registered TCM physician and also tuina etc.service by therapist in this clinic.本人要求及同意接受诊所内注册医师所施予的针灸等相关中医治疗以及治疗师所施予的推拿等理疗服务。

    I understand and am informed that in the performance of acupuncture and/or other relater procedures, there are some risks to treatment which include, but not limited to, bleeding,bruising, pain, faint, convulsions, burn, stuck or bent needles and any other risks as informed by the Physician.本人经医师解释并了解针灸及相关治疗时有可能发生的预后情况，如出血，淤血，疼痛，惊厥，烫伤，滞针，弯针等。

    I do not expect the Physician/Therapist to be able to anticipate and explain all possible risks and complications, I wish to rely on the Physician/Therapist to exercise his/her judgement during the course of treatment to his/her best ability.本人了解不应期望医师/治疗师能预知并解释所有风险及预后情况。本人希望依赖医师/治疗师的经验与判断得到适当的治疗。

    The provision of our Facility; products and services to you are governed by the terms and conditions herein; our Terms of Trade (https://guoantangtcm.com/term-of-trade/); and our Privacy Policy (https://guoantangtcm.com/privacy-policy/ ), which form the Agreement between us. Please read the terms and disclaimers contained therein carefully. BY USING OUR FACILITY; AND/OR ANY OF OUR PRODUCTS AND SERVICES, YOU ARE AGREEING TO ALL THE TERMS CONTAINED IN THE AGREEMENT.