Anupa Wellness Right Black-small.jpg

Mandatory Disclosure Statement, Informed Consent

Laura Deloatch, DVM, CVA, L.Ac, Dipl. OM --  Anupa Wellness -- LD Acupuncture

This disclosure statement is in compliance with the State of Colorado, Department of Regulatory Agencies, Colorado Statute Title 12 Article 29.5.   All rules and regulations set forth by the Department of Health are strictly adhered to including proper cleaning, sterilization, and sanitation of equipment and office.


Education and Experience:

Laura Deloatch, DVM, L.Ac, Dipl OM, CVA graduated from Ross University School of Veterinary Medicine in 2000. She became certified in veterinary Chinese herbal medicine in 2003 and a Certified Veterinary Acupuncturist from the Chi Institute of Chinese Medicine in 2007.

Laura completed her Masters of Traditional Chinese Medicine degree from the Colorado School for Traditional Chinese Medicine in 2009.  The three year program consists of 2,850 hours of education including 990 hours of clinical practice. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) certified Laura as a Diplomat of Oriental Medicine and Acupuncture in April of 2009. This includes certification in Clean Needle Technique and Chinese Herbology.

Laura’s training includes acupuncture, internal medicine, moxibustion, tui na, cupping, auriculotherapy, electrical stimulation, Chinese herbal medicine as well as dietary and lifestyle recommendations.

Laura is a licensed veterinarian and acupuncturist. She is also licensed as a Diplomat of Oriental Medicine through the State of Colorado.  None of these licenses have been revoked or suspended.  Laura is a member of the Acupuncture Association of Colorado.  Laura complies with the rules and regulations set forth by the Colorado Department of Health, including the proper cleaning and sanitation of area and proper disposal of used needles. Only single-use, disposable, factory-sterilized needles are used.


Fee Schedule:

People:

  • Community Acupuncture           $35
  • Initial Private Acupuncture Treatment      $125       
  • Follow-up Acupuncture Treatments    $75
  • Fire Cupping                $35
  • Methylcobalamin Injection at an Acupuncture Point   $25

Cats/Dogs:

  • Initial Consult & Treatment        $125     
  • Follow-up Treatments            $75

Horses:

  • Initial Consult & Treatment        $125        
  • Follow-up Treatments               $85        
  • plus Farm Call                 depends on location

No Show or Late Cancellation Fee

A No Show or a Late Cancellation Fee may be up to the full cost of the appointment.
                                                                           
Herbal Medicine is not included.


Patient’s Rights:

  • The patient is entitled to receive information about the methods of therapy, the techniques used, and the duration of the therapy (if known).

  • The patient may seek a second opinion from another healthcare professional or may terminate therapy at any time.

  • In a professional relationship, sexual intimacy is never appropriate and should be reported to the Director of the Division of Registration in the Department of Regulatory Agencies (DORA).

The practice of acupuncture is regulated by the Colorado Department of Regulatory Agencies (DORA).  
The Director’s address and telephone number is:    
Director, Division of Registrations, Acupuncturists Licensure
1560 Broadway, Suite 1350  Denver, CO 80202      (303) 894-7800

The practice of veterinary medicine is regulated by the Colorado Department of Regulatory Agencies (DORA).
The State Board of Veterinary Medicine’s address and telephone number is:
1560 Broadway, Suite 1350  Denver, CO 80202      (303) 894-7800


Informed Consent:

I hereby request and consent to the performance of acupuncture treatments and other procedures within the scope of practice of acupuncture on me by Laura Deloatch, DVM, CVA,  L.Ac, Dipl. OM. I understand that methods of treatment may include, but not limited to acupuncture, moxibustion, cupping, electrical stimulation, Tui-Na, Gua-Sha, Chinese herbal medicine and nutritional counseling.

I understand that herbs need to be prepared and consumed to the instructions provided. I will immediately notify Laura Deloatch DVM, CVA, L.Ac, Dipl. OM if any unanticipated or unpleasant effects possibly associated with the consumption of herbs. Although the herbs and nutritional supplements that have been recommended are traditionally considered safe in the practice of Chinese Medicine, some may be toxic in large doses. I understand that some herbs may be inappropriate during pregnancy. Some possible side effects of taking herbs are nausea, gas, stomach ache, vomiting, headache, diarrhea, rashes, hives and tingling of the tongue.
I have been informed that acupuncture is a safe method of treatment but that it may have side effects including dizziness or fainting. Please communicate to Laura Deloatch, DVM, CVA, L. Ac, Dipl OM if you are feeling any light headedness.

There may be discomfort, pain, bruising, numbness or tingling at site of needle that may last a few days.  Unusual risks of acupuncture  include nerve damage, organ puncture, possibility of miscarriage, burns from moxibustion or heating lamps. Infection is another possible risk, although Laura Deloatch DVM, CVA, L.Ac, Dipl OM  uses sterile disposable needles and maintains a clean and safe environment.

Injection of 1000mcg of Methylcobalamin into acupuncture points may also cause bruising at the site of injection. Although the Methylcobalamin is preservative- free, serious reactions may be seen. Please communicate any adverse reactions with Laura Deloatch, DVM, CVA, L.AC, Dipl OM. If I am allergic or having any allergic reactions due to the Methylcobalamin, I will immediately inform Laura Deloatch, DVM, CVA, L. AC, Dipl OM.

Bruising is a common side effect of cupping and Gua-sha. Burns and or scarring is a potential but rare risk of moxibustion and cupping.

Other side effects and risk may occur.  If I suspect that I or my pet is pregnant I will immediately inform Laura Deloatch, DVM, CVA, L.Ac, Dipl. OM. 
 
I understand that there may be limitations to the care provided and that, in my best interest, I may be referred to another acupuncture practitioner or other healthcare provider who may be more qualified to treat me outside of these facilities.  I do not expect Laura Deloatch, DVM, CVA, L.Ac, Dipl. OM to explain or anticipate all risks or complications of treatment and I wish to rely on her to exercise judgement during the course of treatment which is based upon the known facts that is in my best interest. I understand that I have the choice to accept or reject treatment at any time.

I understand Laura Deloatch, DVM, CVA, L. Ac, Dipl OM may review my patient records and lab reports, but all of my records will be kept confidential and will not be released without my written consent.

By voluntarily signing below, I show that I have read or have been read to me and understand the above consent to treatment.  Also, I have had the opportunity to ask questions regarding this consent. I intend this form to cover the entire course of treatment for my condition and for any future condition (s) for which I seek treatment.


_______________________________________________________________________________
Signature of Patient/Participant or Parent and receipt of HIPPA Privacy Policy