Acupuncture Health Screening & Consent

About this template

This Acupuncture Health Screening & Consent form is designed for Traditional Chinese Medicine (TCM) practitioners and acupuncturists in Switzerland. It combines the health screening necessary to identify contraindications and safety considerations with an informed consent process that explains the nature of acupuncture treatment, common side effects, and the patient's right to withdraw consent. All sensitive health data is stored end-to-end encrypted under the Swiss Federal Act on Data Protection (nFADP).

What this form collects

• Contact details and referring practitioner
• Chief complaint and reason for seeking acupuncture
• Current medical conditions and diagnoses
• Current medications — with emphasis on anticoagulants and drugs affecting bleeding
• Known allergies — particularly to metals and adhesives used in needle placement
• Pregnancy or potential pregnancy status
• Bleeding disorders and blood-borne disease disclosure
• Pacemaker and implanted device status
• Needle phobia or prior adverse reactions to acupuncture
• Skin conditions at intended needle sites
• Informed consent: explanation of the treatment, risks, and alternatives
• Right to withdraw consent and stop treatment at any time
• Signature and data protection consent

How to use this template

Acupuncture safety: key contraindications and precautions

Acupuncture is a broadly safe procedure when performed by a trained practitioner using sterile single-use needles. However, several patient conditions require either modified technique, additional precautions, or outright contraindication to treatment at certain sites or entirely. The health screening portion of this form is designed to surface these:

• Anticoagulant therapy: Patients taking warfarin, direct oral anticoagulants (DOACs — apixaban, rivaroxaban, dabigatran), heparin, aspirin in anticoagulant doses, or clopidogrel have elevated bleeding risk at needle sites. Point selection and needle retention require modification.
• Pregnancy: Many acupuncture points are traditionally contraindicated during pregnancy (particularly points that stimulate uterine contractions: LI4, SP6, BL67, and others). Screening for pregnancy and gestational stage is mandatory.
• Pacemakers and implanted electronic devices: Electroacupuncture (E-stim) is absolutely contraindicated in patients with pacemakers. Standard acupuncture can proceed with appropriate point selection.
• Bleeding disorders and clotting dysfunction: Active haemophilia, thrombocytopenia, or von Willebrand disease significantly increase bleeding risk from needle insertion.
• Skin conditions and infections: Open wounds, active infections, eczema, psoriasis, or dermatitis at intended needle sites — needling through compromised skin introduces infection risk.
• Needle phobia or prior fainting: Significant needle phobia or prior vasovagal response (fainting) to acupuncture or blood draws requires adaptive technique (lighter stimulation, patient supine, shorter session).
• Metal allergy: Rare but relevant — some patients have nickel or stainless steel sensitivity. Titanium or gold needles may be indicated.
• First trimester of pregnancy: Most practitioners significantly limit treatment in the first 12 weeks given the elevated miscarriage risk in this period.

What informed consent for acupuncture must include

Informed consent for acupuncture — as for any physical intervention — must cover the following to be legally and ethically valid:

• Explanation of the treatment: what acupuncture is, how needles are inserted, typical session duration and frequency.
• Common side effects: local soreness, bruising, minor bleeding, temporary fatigue, occasional emotional release, lightheadedness.
• Serious but rare risks: haematoma, infection (extremely rare with sterile single-use needles), pneumothorax (risk with thoracic points), organ puncture (risk with deep abdominal/lumbar points in untrained hands).
• Right to withdraw: the patient may withdraw consent and stop treatment at any time without disadvantage.
• Alternative options: the patient is aware that they have the option to seek other forms of treatment.
• Voluntary consent: the patient consents freely and without coercion.
• Documented: the consent is signed and dated and a record is retained by the practice.

TCM practitioner qualification in Switzerland

In Switzerland, Traditional Chinese Medicine practitioners may be qualified as medical doctors, physiotherapists, nurses, or naturopathic practitioners with TCM specialisation. Acupuncture is included in the supplemental insurance (Zusatzversicherung / VVG) benefit packages of most major Swiss health insurers when performed by a practitioner registered with one of the recognised registers: EMR (Erweiterte Massnamen Register) or ASCA. To be reimbursed, the practitioner typically holds an EMR or ASCA registration in acupuncture.

Medical doctors (Allgemeinmediziner / Hausarzt) certified in acupuncture by the SMGP (Swiss Medical Society of Acupuncture and Traditional Chinese Medicine) or by cantonal medical associations can bill acupuncture to the basic insurance (KVG / LAMal) for specific indications.

Data protection for acupuncture practices

Health data in an acupuncture intake — including diagnosis history, medications, pregnancy status, and blood-borne disease disclosure — is sensitive personal data under Art. 5 nDSG. The practice must: obtain explicit written consent before processing; store the data securely (end-to-end encryption or equivalent); restrict access to treating staff; retain records for 10 years from the last treatment (standard Swiss medical record retention guideline); and be prepared to action requests for access, correction, or deletion.

Frequently asked questions

Does an acupuncture practitioner have a duty to inform patients about risks?

Yes. The practitioner's duty to inform (Aufklärungspflicht) is a cornerstone of Swiss health law and applies to complementary practitioners as well as physicians. The patient must be informed about the nature of the treatment, its common side effects, and any significant risks before giving consent. An unsigned or undated consent form does not adequately document this duty.

Can a patient withdraw consent during a session?

Absolutely. Consent to a physical treatment is always revocable. If a patient is uncomfortable during a session and asks to stop, needles must be removed and the session ended immediately. Documenting in the patient's record that the session was terminated at their request and the reason is good practice.

Should the consent form be re-obtained for every appointment?

A first-appointment consent form covers the ongoing therapeutic relationship for the treatment modality. However, if there are material changes (new diagnoses, new medications, pregnancy, or a change in the treatment approach), it is good practice to document fresh consent. At minimum, the health screening should be confirmed or updated at each appointment.

How does this differ from the Complementary Therapy Intake form?

The Complementary Therapy Intake covers broad health history for the full new-client assessment in any complementary modality. This Acupuncture Consent & Intake form is narrower and specifically focused on: (a) safety contraindications specific to needling, (b) informed consent for a physical intervention (inserting needles), and (c) needle-specific considerations such as metal allergy, needle phobia, and electroacupuncture contraindications. For acupuncture first appointments, both forms together provide complete coverage.

See also our Complementary Therapy Intake template on Schweizerform for the full first-appointment health history and lifestyle assessment covering all complementary modalities.