Thank you for taking an interest in engaging with services provided by Charlotte Hazeldine Chinese Medicine (‘CHCM’). Please read this document carefully. By signing the Patient Consent Form you or your authorised person(s) acknowledge that you understand and accept the following Terms and Conditions and all policies referred to herein.

If you do not agree, or cannot comply with any of the following Terms and Conditions, do not book a consultation and/or treatment and/or make payment and do not attempt to access the CHCM site.

If you have any questions or concerns, please do not hesitate to contact CHCM by email at acupuncture@charlottehazeldine.com.

HEALTH & WELLBEING

Medical History

It is the patient’s (or authorised person’s) responsibility to provide CHCM with a comprehensive, correct, honest and true medical history. CHCM will not be held responsible for any issues which may arise due to the patient’s (or authorised person’s) failure to provide vital and necessary information which may affect the patient’s treatment plan. 

Lifestyle Advice 

Any lifestyle advice provided by CHCM is strongly recommended to be followed to assist the treatment being given by CHCM as well as the patient’s wellbeing. Any advice not followed may have an effect on any progress. CHCM will not be held responsible for any poor performance due to the patient’s failure to follow lifestyle advice.

Medical Emergency and Red Flags

On patient history and/or clinical examination, if a patient presents with red flag indicators i.e. signs and symptoms which indicate considerations of a possible serious condition(s) that requires immediate medical attention, CHCM reserves the right to refuse treatment and/or alter the patient treatment plan. CHCM shall discuss any concerns with the patient (and/or authorised person(s)) accordingly. On assessment CHCM may continue treatment if they are satisfied all concerns have been suitably addressed and/or evidence is provided by the patient’s doctor stating it is safe to continue treatment. 

In situations which present as a medical emergency CHCM reserves the right to intervene by seeking and/or performing the necessary aid in order to help the patient. This may include, but is not limited to; performing first aid, calling the Ambulance service as well as contacting the patient’s medical emergency contact.

CHCM is not responsible for any issues which may arise as a result of the patient’s (and/or authorised person’s) failure to follow CHCM’s advice or recommendations concerning medical emergencies or red flag concerns.

Right to Refuse to Treat

CHCM reserves the right to refuse treatment if CHCM deems that any treatment will not be in the best interest of the patient and will compromise their health. CHCM shall discuss any concerns with the patient (and/or authorised person(s)) accordingly.

Right to Alter the Patient’s Treatment Plan 

CHCM reserves the right to alter the patient’s treatment plan if CHCM deems that any treatment shall not be or is no longer in the best interest of the patient and/or will compromise their health. CHCM shall discuss any concerns with the patient (and/or authorised person(s)) accordingly.

TREATMENT INFORMATION

Treatment Results

Whilst many patients are happy and satisfied with their treatment(s), results may vary for each individual owing to their individual circumstances, therefore CHCM cannot guarantee specific results. Proceeding with a consultation and thereafter any subsequent treatment(s) acknowledges the patient’s understanding and agreement to this. If CHCM assesses that a treatment will not be suitable for the patient for whatever reason, CHCM will discuss reasons as to why with the patient (and/or authorised person(s)) accordingly.

Treatments, their Risks and Side Effects

It is important to understand that with any medical treatment there are potential risks and side effects. The patient (and/or authorised person(s)) shall carefully read in full, all treatment information as well as their possible risks and side effects on the treatments page prior to commencing any treatment with CHCM.


Should the patient (and/or authorised person(s)) have any concerns regarding any treatments or their risks and side effects, they may contact CHCM by phone or email see contacts page.

Pre-Treatment Instructions and Aftercare 

CHCM may provide patients with pre-treatment and aftercare instructions. CHCM strongly recommends the patient adheres to all pre-treatment and aftercare instructions as failure to do so may impact the patient’s health as well as the effectiveness of treatment. CHCM is not responsible for any issues or poor progress which may result from the patient’s failure to comply with any/all pre-treatment or aftercare instructions. CHCM has the right to refuse treatment or alter the patient’s treatment plan if CHCM deems that any treatment will not be in the best interest of the patient and will compromise their health. CHCM shall discuss any concerns with the patient (and/or authorised person(s)) accordingly.

Children

CHCM may treat children (persons under 18 years of age). Charlotte Hazeldine is DBS certified and shall keep this updated accordingly. 

Children must be accompanied by a parent or appointed guardian, who must remain on the premises until treatment is complete.

All forms must be completed by a parent or legal guardian. Once the child reaches 18 years of age they are recognised as a competent adult, and will be required to complete the forms again signing on their own behalf. 

Right to Refuse to Treat

CHCM reserves the right to refuse treatment, which includes, but is not limited to:

  • if CHCM deems that any treatment will not be in the best interest of the patient and will compromise their health. This may include, but is not limited to, if the patient presents with red flag symptoms, has a medical emergency and if the patient fails to comply with pre-treatment and aftercare instructions. 
  • if the patient is using abusive language or aggressive behaviour.
  • if the patient is under the influence of alcohol or drugs.

CONFIDENTIALITY & CONSENT

All patients have a right to confidentiality and consent, this includes children over the age of 12 years who are deemed competent. CHCM shall respect the patient’s wishes with regards to confidentiality and consent. CHCM reserves the right to break the patient’s confidentiality in situations where CHCM deems the patient is a health and safety risk to either themselves or someone else. 

Authorised Persons

CHCM may share and discuss any/all medical matters relating to the patient, including any treatment(s) delivered by CHCM with a third party, provided the patient consents and the third party is registered as an authorised person with CHCM. 

The third party must submit the following documents which will be kept on file:

  • POA:
    • Copy of the POA document (electronic copy will suffice).
    • Form of photographic ID.
  • Other e.g. carer/trusted person:
    • Third party consent form to be signed in front of practitioner. 
    • Form of photographic ID.
  • GP
    • Patient to complete GP details on the Patient Consent Form.

Children & Confidentiality

CHCM recognises and implements the government’s position on child consent and confidentiality; provided that a child is deemed competent, then they have the same rights to confidentiality as an adult. 

Department of Health, Confidentiality NHS Code of Practice, November 2003

CHCM, as the medical practitioner, shall consider whether a child under 16 years has competency using the government guidelines. CHCM reserves the right to, at any time, disclose the child patient’s medical information to a relevant third party if, by respecting the patient’s confidentiality rights, it compromises the health and safety of the patient or someone else.

Consent 

Consent is an ongoing process. The patient retains the right to withdraw consent at any time for

  • Third party’s to be informed. 
  • Any/all treatments.

This must be followed up in writing and sent to admin@charlottehazeldine.com

Breaking Confidentiality

CHCM reserves the right to disclose the patient’s medical information to a relevant third party if, by respecting the patient’s confidentiality rights, it compromises the health and safety of the patient or someone else. CHCM shall not be responsible for any issues which may arise as a result of breaking the patient’s confidentiality under these circumstances.

ASSISTANCE

Pets

Strictly no pets other than assistance dogs are permitted on the premises. 

CHCM understands and respects the vital role assistance dogs have. Assistance dogs are therefore permitted and may remain in the treatment room whilst the patient is receiving treatment. However, please understand that due to the nature of some treatments (e.g. acupuncture) it is important that CHCM maintains a clean environment for the health and well-being of all patients. Therefore, patient’s requiring assistance dogs shall adhere to the following terms and conditions:

  • On making a treatment booking, to inform CHCM an assistance dog will be attending.
  • The assistance dog remains the responsibility of the patient at all times whilst on the clinic premises. 
  • It is the patient’s responsibility to make sure their assistance dog remains in the allocated space in the treatment room whilst the patient is receiving treatment. 
  • It is the patient’s responsibility to make sure their assistance dog is fully vaccinated and regularly checked by a vet, as they are not exempt from the Health and Safety Regulations. 

CHCM shall take all reasonable measures to make sure the patient receives a safe and clean treatment whilst the assistance dog is in attendance. However, CHCM is not responsible for any issues which may arise due to the patient requiring the aid of an assistance dog.

PRICE, PAYMENT, INSURANCE & CANCELLATIONS

Price 

CHCM shall display current treatment prices on the treatment pricing page. CHCM reserves the right to change treatment prices from time to time. Regular patients may be informed of any increase in charges by the contact email they provided on the Patient Consent Form. However, it is ultimately the patient’s responsibility to check current treatment pricing before booking any treatments with CHCM.

Payment

Payment is due in full after the appointment. Bank transfer, card or by payment link is accepted. Cash is NOT accepted. The patient (and/or authorised person(s)) will pay accordingly. 

Cancellation fees are due 48hrs after the intended appointment. Cancellation fees are 50% of the appointment charge if the cancellation is made less than 48hrs notice or 100% for ‘no-shows’, charged at the discretion of CHCM. The patient shall transfer the funds promptly.

Please refer to the cancellation section for further details.

Insurance

As part of membership with BAcC the insurance is part of this. It is held with Lockton.

Cancellations

CHCM understands that there may be occasions where the patient may need to cancel or reschedule their appointment. These conditions ensure fairness to both CHCM’s valued patients and business. By booking an appointment with CHCM and signing the Patient Consent Form, the patient acknowledges and agrees to the following:

  • Notice

CHCM requires 48hrs notice for any appointment cancellation or rescheduling. Emails should be sent to acupuncture@charlottehazeldine.com. Less than 48hrs notice may result in a cancellation fee of 50% of the appointment price, charged at the discretion of CHCM. This charge is to cover costs including renting the clinic space and making sure it is clean and safe, as well as organising another client to fill the last-minute appointment slot.  

CHCM recommends the patient obtains and retains a confirmation of the appointment cancellation or rescheduling to ensure proper record-keeping.

  • Rescheduling

CHCM shall do their best to accommodate the patient’s request based on availability.

  • Non-attendance or “No-show”

If the patient fails to show up for their scheduled appointment without any prior notice, they will be considered a “no-show.” No-shows may result in a cancellation fee of 100% of the appointment price, charged at the discretion of CHCM and may affect the patient’s ability to schedule future appointments. CHCM will give a 15-minute grace period, after which, it shall be presumed the patient is not attending. 

  • Running late

If the patient fails to contact CHCM by phone (01296 696133) or email (acupuncture@charlottehazeldine.com), CHCM shall give a 15-minute grace period, after which, it is presumed the patient shall not be attending. The “No-show” conditions will apply.

If the patient has been in contact by phone (01296 696133) or email (acupuncture@charlottehazeldine.com), CHCM shall do their best to accommodate the patient once they have arrived. The patient shall understand and accept they may not receive the full allotted treatment time due to room bookings. CHCM reserves the right to refuse to treat and/or change the patient’s treatment plan if CHCM deems that any treatment shall not be or is no longer in the best interest of the patient and/or will compromise their health. CHCM shall discuss any concerns with the patient (and/or authorised person(s)) accordingly. Appointment charges shall be made at the discretion of CHCM.

  • Unforeseen Circumstances

CHCM understands that unforeseen circumstances may arise, and may make exceptions for emergencies or unavoidable situations. The patient shall contact CHCM by phone (01296 696133) or email (acupuncture@charlottehazeldine.com) at their earliest convenience to discuss the situation and potential alternatives. 

  • CHCM Delay & Cancellations

CHCM shall aim to ensure the patient’s appointment runs to time. CHCM may communicate any substantial delay to the patient’s appointment time using the patient details supplied on the Patient Consent Form should any such matters arise. CHCM shall give as much notice as reasonably possible.

CHCM reserves the right to cancel or postpone appointments at short notice due to unforeseen circumstances. CHCM shall contact the patient using the patient details supplied on the Patient Consent Form should any such matters arise. CHCM shall give as much notice as reasonably possible.

CHCM shall not be held liable for any issues which may arise from a delay to treatment time or unforeseen circumstances cancellations. 
CHCM apologies in advance for any inconvenience caused. CHCM appreciates the patient’s (and/or authorised person(s)) understanding and cooperation. If anyone has any questions or concerns regarding CHCM’s appointment cancellation terms and conditions, please contact acupuncture@charlottehazeldine.com.

LIABILITY
CHCM does not exclude or limit in any way their liability to the patient where it would be unlawful to do so. CHCM will not be liable in contract, tort or otherwise for any economic loss (including, without limitation, loss of profit), or for any other special, indirect, or consequential loss or damage arising out of, or in connection with, its provision of any services to the patient.

TRANSPARENCY

GDPR/Privacy Policy

CHCM takes the safety and privacy of all patient’s (and/or authorised persons) personal details very seriously. The patient (and/or authorised persons) may refer to CHCM’s GDPR policy to understand how their personal information is stored and used.

Patient records 

A patient (or authorised person) may request a copy of the patient’s treatment records in writing by email (acupuncture@charlottehazeldine.com) with sufficient proof of ID. Once acknowledging and accepting this written request, CHCM shall aim to provide a copy of the patient’s treatment records usually within 2 to 4 weeks. CHCM shall provide the patient with their records via email, unless otherwise discussed. CHCM is not liable in any way if copies of the patient’s treatment records are lost or accessed by others once given by hand or emailed out securely. If records are sent via post, CHCM is not liable in any way if copies of the patient’s treatment records are lost or accessed by others. Any charges incurred as a result of fulfilling this request shall be charged to the patient, at the discretion of CHCM.

Complaints

As a first port of call the patient should contact acupuncture@charlottehazeldine.com with ‘Complaint [insert first name and surname]’ in the subject title, where CHCM will try and resolve any issues or concerns the patient (and/or authorised persons) may have.

If no resolve can be found the patient (and/or authorised persons) can then elevate their complaint to the British Acupuncture Council (BAcC).

OTHER

Home Treatments

The patient is responsible for organising and maintaining a suitable, clean and safe environment for CHCM to perform any home treatment(s) and for the treatment(s) duration. All pets (excluding assistance dogs) shall remain in a different room to the one in which treatment is being provided, at the discretion of CHCM.

CHCM reserves the right to refuse treatment if CHCM deems that any treatment shall not be in the best interest of the patient and/or may compromise their health and safety and/or may compromise the health and safety of the practitioner. CHCM may impose a cancellation fee of 50% of the appointment price, charged at the discretion of CHCM.

Multibed Treatments

Due to the nature of a multibed setting personal privacy is limited in comparison to a 1-1 treatment, if you wish to discuss a private matter CHCM will make every effort to ensure your privacy but it cannot be guaranteed. Please do share any private information in the initial 1-1 consultation beforehand or by contacting me directly at any time.

Abusive Language or Aggressive Behaviour

Abusive language or aggressive behaviour is strictly not tolerated. CHCM is dedicated to providing a supportive service and environment which aims to help people and their conditions. CHCM therefore reserves the right to withdraw any services and demand the individual(s) to leave the premises, or shall immediately leave the patient’s home, should any persons exhibit behaviour which is deemed abusive or aggressive. Medical conditions will be at the discretion of CHCM. 

Valuables & Personal Belongings

CHCM takes no responsibility for the loss or damage of any patient’s or visitor’s valuables or personal belongings. Patients and visitors shall check upon leaving the clinic that they have all their items with them.

Parking

Parking at the Chilterns Neuro Centre is strictly for Chilterns Neuro Centre members only. parking is available around the residential area surrounding the centre. Patients and visitors shall be mindful of where they park and shall not obstruct residents’ driveways or park in any residential bays. Patients shall allow themselves enough time to find parking. CHCM shall not be responsible for any issues or penalties which may arise from the patient’s failure to find appropriate parking.

Author

admin@charlottehazeldine.com

I am fully qualified Traditional Chinese Medicine Practitioner (TCM), who studied at The City College of Acupuncture. I have been trained to meet the requirements of the British Acupuncture Accreditation Board and practice acupuncture in compliance with the requirements of the Professional Standards Authority for Health and Social Care (PSA).