INFORMED CONSENT TO CNMCO Holistic & Natural Body Management
Below are the Professional managements Provided by the CNMCO Certified Practitioners from CNMCO Holistic
& Natural Body Management:
E & W. Natural Medicine Herbology, Bio Multi-Pointed CHIM Therapy, Acupuncture, Moxa Cupping Therapy,
Acupressure Shiatsu Healing Touch, Vitamin & Mineral, Tuina Therapeutic Touch, Reflexology, Aromatherapy,
Polarity Therapy, Oriental Stone Therapy, Lymph therapy, Oriental Bodyworks, Oriental Reiki Detoxification,
Oriental Nutritional Counseling, Holistic Counseling, Glacial Clay Heat therapy, and Alternative therapy, etc.
I hereby request and consent to the performance of the whole management above, by the CNMCO Certified
Practitioners below. I have had an opportunity to discuss with the CNMCO Certified Practitioners above and
with other office or CNMCO Holistic & Natural Body Management personnel the nature and purpose of the
whole management and other cares.
I understand that results are not guaranteed. I understand and am
informed that, as in the practice of the management above, there are some risks to management, natural
improvement reaction that might last for about ten days, including but not limited to some skin spots, swelling,
bruises, several days’ of pain or skin scraping, blood vessel rupture, such as capillary vessels rupture, bleeding,
headache, nausea, vomiting, tingling sensation, fever all over the body, seizure, post-care stress, fright, anxiety,
insomnia, severe pain on the managed spot, diarrhea, and constipation caused from the management as well as
the Herbal. I will Not file any complaints for the management, and Herbal as well as the Natural Improvement
reaction indicated above that can happen after the care.
I am also aware that the CNMCO Certified practitioners from CNMCO Holistic & Natural Body Management
above to be able to anticipate and explain all risks and complications, natural improvement reaction and I wish
to rely upon the CNMCO Certified practitioners to exercise judgment during the course of the care which the
practitioner feels at the time, based upon the facts then known to him or her, is in my best interest.
read, or have had read to me, the above consent.
I have
I have also had an opportunity to ask questions about its
content, and by signing below I agree to the above-named care. I intend this consent form to cover the entire
course of management for my present condition and for any future condition(s) or which I seek management.
By signing consent below, I acknowledge my acceptance and understanding of this informed consent.
Date
CNMCO Member Name & Signature______________________
Witness Name & Signature______________________