office policies

Cancellation Policy

Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the practitioner's day that could have been filled by another patient. As such, we require 24 hours notice for any cancellations or changes to your appointment. Patients who provide less than 24 hours notice, or miss their appointment, will be charged a cancellation fee.

Privacy and Sharing of Information

I authorize the clinic and its associated health professionals to collect my personal and medical information as documented above. In addition, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as deemed necessary for my beneficial treatment. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission.

Informed Consent for Assessment of Pelvic Floor and Lower Abdominal Dysfunction

REFERRAL & ASSESMENT: I have been referred to acupuncture for treatment of pelvic floor and/or lower abdominal dysfunction. I understand that if I undertake acupuncture treatment for pelvic floor and lower abdominal dysfunction, it will be beneficial for my acupuncturist/dry needling acupuncturist to assess active/reactive triggerpoints, tenderness, and adhesions, initially and periodically, in sensitive areas. At times, these assessments may be most directly and effectively performed via the vagina and/or rectum. Evaluation of my condition may therefore include observation and direct muscle palpation in these areas.

PELVIC FLOOR DYSFUNCTIONS: Pelvic floor dysfunctions include, but are not limited to, pelvic pain syndromes, urinary incontinence, fecal incontinence, dyspareunia, or pain with intercourse, pain from an episiotomy or scarring, vulvodynia, vestibulitis, constipation, pain with urination or defecation, diffuse gluteal pain, organ prolapse, diffuse lower extremity pain, or other similar complications.

BENEFITS AND OPTIONS: The benefits of the vaginal/rectal assessment have been explained to me. I understand that if I am uncomfortable with the assessment or treatment procedures AT ANY TIME, I will inform my acupuncturist/dry needling acupuncturist and she/he/they will discontinue the assessment or treatment, and discuss the procedure and possible alternatives with me. I will then decide whether or not to continue with the internal assessment/treatment or to suspend it. External treatments may still be utilized.

TREATMENTS: Acupuncture and Acupuncture Dry Needling treatment procedures for pelvic floor and lower abdominal dysfunctions may include, without limitation, education, exercise, stimulation, needling, electrostimulation, and/or insertion of heated or cooled materials into rectum or vagina. The acupuncturist will explain to me all treatment procedures proposed for me, and I may choose whether to participate with all or part of the treatment plan.

SCOPE: I understand that the scope of this treatment is limited to neurological, neuromuscular, and, musculoskeletal complaints. I understand that the acupuncturist is in no way conducting any gynecological exam or treatment.

RISKS/SIDE EFFECTS: Risks and side effects may include: All risks listed on the informed consent form of Dr. Bobbie Jo Putnam, DAc, L.OM, including, but not limited to: Muscle and joint soreness, bruising, needle sickness, dizziness or fainting, needle breakage, referred discomfort to another part of the body, fatigue, nerve damage, and temporary discomfort with defecation, walking, or activities of daily living. Unusual risks of pelvic floor acupuncture in the rectal/vaginal/perineal region may include risk of infection due to inability to swab mucous membranes with alcohol, prostate, or other organ puncture I understand that no guarantees have been or can be provided to me regarding the success of acupuncture therapy.

I have read or had read to me the foregoing “INFORMED CONSENT for TREATMENT of PELVIC FLOOR and LOWER ABDOMINAL DYSFUNCTION, and any questions that may have occurred to me, have been answered to my satisfaction. I understand the risks, benefits, and alternatives of the treatment.

NOTE: If you are pregnant, have an infection of ANY KIND, have vaginal dryness, are less than six weeks postpartum, post surgery, have SEVERE pelvic pain, sensitivity to KY Jelly, lubricants, vaginal creams or LATEX, please inform the acupuncturist prior to the pelvic floor assessment.