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Informed Consent for Group Clinical Services

This Informed Consent ("Consent") governs the provision of group clinical services by Yuè Health Services, PLLC ("Yuè Health Services," "we," "our," or "us").

The purpose of this Consent is to ensure that patients understand the nature of the group clinical services being provided, the potential benefits and risks of treatment, available alternatives, and the unique considerations associated with receiving healthcare within a shared treatment environment.

1. Nature of Group Clinical Services

Group clinical services are healthcare services provided simultaneously to multiple patients within a shared treatment environment. While care occurs in a communal setting, each patient's treatment is based upon an individualized clinical assessment informed by their health history, presenting concerns, treatment goals, and clinical presentation.

Depending upon the nature of the program, services may be provided in reclining chairs, treatment tables, floor mats, or other appropriate clinical settings.

I understand that receiving healthcare in a group setting differs from receiving care during an individual clinical appointment but does not alter the professional standards governing my care.

2. Limitations and Characteristics of Group Clinical Care

Group clinical services are designed to provide safe, effective, and accessible care within a shared treatment environment.

I understand that treatment provided in a group setting differs from individualized private care. While my practitioner will consider my health history, presenting concerns, and clinical presentation when determining an appropriate treatment approach, the scope of evaluation, treatment planning, and therapeutic interventions may be more focused and streamlined than those provided during an individual clinical appointment.

Depending on the nature of the group program, treatment may incorporate standardized or semi-standardized clinical approaches designed to safely address common health concerns shared among participants. Although treatment remains individualized within the practitioner's professional judgment, group clinical services are not intended to provide the same depth, duration, privacy, or breadth of individualized assessment and intervention that may be available during private one-on-one care.

If my practitioner determines that my condition requires a more comprehensive evaluation or individualized treatment approach than can reasonably be provided within the group setting, I understand that I may be referred for an individual appointment or advised to seek additional medical evaluation or care.

3. Practitioner–Patient Relationship

I understand that by voluntarily receiving group clinical services through Yuè Health Services, PLLC, I am entering into a practitioner-patient relationship with a licensed Acupuncture Physician.

All clinical services are provided in accordance with applicable Florida law, accepted professional standards of practice, and the practitioner's clinical judgment.

This practitioner-patient relationship is separate from any educational programs, workshops, retail products, or community offerings provided through Yuè Collective, LLC.

4. Scope of Group Clinical Services

Depending upon my individual clinical needs and the nature of the group treatment session, my care may include one or more of the following services when clinically appropriate:

  • Acupuncture;
  • Auricular acupuncture;
  • Acupressure;
  • Moxibustion;
  • Cupping therapy;
  • Gua sha;
  • Therapeutic bodywork or manual therapies within the practitioner's professional scope of practice;
  • Breathing exercises;
  • Therapeutic movement and Qigong instruction;
  • Meditation or relaxation techniques;
  • Lifestyle and self-care education;
  • Traditional East Asian medicine recommendations; and
  • Other therapies lawfully provided within the practitioner's professional scope of practice.

I understand that not every group treatment session will include every modality listed above.

I further understand that the specific therapies utilized during any session will be determined by my practitioner's clinical judgment in consultation with me and may change from session to session based upon my condition, treatment response, safety considerations, evolving clinical findings, or other relevant clinical factors.

5. Clinical Decision-Making & Modification of Treatment

I understand that healthcare is an evolving process and that my treatment plan may be modified as my condition changes or new clinical information becomes available.

I authorize my practitioner to exercise professional judgment in determining the most appropriate treatment approach during each session. This may include modifying acupuncture point selection, adjusting treatment techniques, adding or omitting therapeutic modalities, changing the frequency or duration of care, or discontinuing a particular intervention when clinically indicated or requested by me.

I understand that these reasonable clinical modifications are intended to promote safe, appropriate, and effective patient care and do not require the execution of a new informed consent unless there is a material change in the nature of the services being provided.

6. Potential Benefits

Potential benefits of treatment may include improvements in pain, physical function, mobility, stress regulation, emotional well-being, sleep, quality of life, and other aspects of health. Individual responses to treatment vary considerably.

I understand that no guarantees or promises regarding treatment outcomes have been made.

7. Risks and Possible Complications

I understand that all healthcare interventions involve inherent risks.

Potential risks associated with acupuncture and related therapies may include, but are not limited to:

  • Temporary soreness or discomfort;
  • Minor bleeding;
  • Bruising;
  • Swelling;
  • Local skin irritation;
  • Temporary worsening of symptoms;
  • Fatigue;
  • Dizziness or lightheadedness;
  • Vasovagal reactions, including fainting;
  • Temporary numbness or tingling;
  • Emotional release or unexpected emotional responses;
  • Burns associated with moxibustion;
  • Skin discoloration or marking associated with cupping or gua sha; and
  • Infection, allergic reaction, or other uncommon complications despite adherence to accepted safety standards.

Although serious complications are uncommon, they may occur.

8. Alternatives to Treatment

I understand that alternatives to treatment include, but are not limited to:

  • Declining treatment;
  • Seeking care from another licensed healthcare provider;
  • Conventional medical evaluation or treatment;
  • Other complementary or integrative healthcare services; or
  • Choosing no treatment.

I understand that I have the opportunity to discuss these alternatives and ask questions before consenting to treatment.

9. Patient Responsibilities

To promote safe and effective care, I agree to:

  • Provide complete and accurate health information, including medications, allergies, medical conditions, surgeries, pregnancy status, implanted medical devices, and other relevant health information;
  • Promptly inform my practitioner of any changes in my health status;
  • Notify my practitioner immediately if I experience pain, dizziness, nausea, emotional distress, or any unexpected reaction during treatment;
  • Follow reasonable treatment and aftercare recommendations; and
  • Ask questions whenever I do not understand any aspect of my care.

10. Shared Treatment Environment

I understand that group clinical services are provided within a shared treatment environment in which other patients may be receiving care simultaneously.

Reasonable efforts will be made to protect my privacy and maintain the confidentiality of my protected health information in accordance with applicable law. However, because treatment occurs in a communal setting, I understand that complete privacy cannot be guaranteed.

I further understand that I may inadvertently observe or overhear limited information relating to other patients during the course of treatment.

In consideration of participating in group clinical services, I agree to respect the privacy and confidentiality of fellow patients and will not intentionally disclose any personal or health-related information that I may observe or overhear.

11. Emergency Medical Assistance

Although serious medical emergencies during treatment are uncommon, I understand that unforeseen circumstances may arise.

If my practitioner reasonably believes that I am experiencing a medical emergency or that emergency medical evaluation or treatment is necessary to protect my health or safety, I authorize Yuè Health Services, PLLC to contact emergency medical services and obtain appropriate emergency assistance on my behalf.

I understand that I remain financially responsible for any emergency medical services provided by third parties.

12. Right to Refuse or Withdraw Consent

I understand that I have the right to ask questions regarding my treatment at any time.

I may refuse any recommended treatment or request that treatment be modified or discontinued before or during any session without affecting my right to seek future care.

Likewise, my practitioner may modify, postpone, or discontinue treatment if, in their professional judgment, doing so is necessary to protect my health, safety, or the safety of others.

13. Consent to Ongoing Group Clinical Care

Unless withdrawn in writing, or unless there is a material change in the nature of the group clinical services provided, I understand that this Informed Consent shall remain in effect for future group clinical services provided by Yuè Health Services, PLLC.

I understand that I may ask questions regarding my care at any time and may withdraw or modify my consent prior to any future treatment.

14. Acknowledgment and Voluntary Consent

By signing below, I acknowledge and agree that:

  • I have carefully read and understand this Informed Consent for Group Clinical Services.
  • I have had the opportunity to ask questions regarding the nature of the proposed treatment, its potential benefits, risks, and available alternatives.
  • I understand the differences between group clinical services and individualized private care.
  • I understand the unique considerations associated with receiving healthcare in a shared treatment environment.
  • I understand that my treatment plan and therapeutic modalities may be modified by my practitioner based upon my individual clinical needs and professional judgment.
  • I understand that no guarantees regarding treatment outcomes have been made.
  • I voluntarily consent to receive group clinical services provided by Yuè Health Services, PLLC.
  • I understand that I may withdraw my consent to treatment at any time prior to or during treatment.

Patient Name: __________________________________________

Patient Signature: _______________________________________

Date: _______________________