＜Consent Form＞

◆　About Acupuncture (including cosmetic acupuncture) and Moxibustion
In acupuncture treatment, since needle is pierced into tissues such as skin, capillaries, muscles, it may be accompanied by bleeding or internal bleeding. If you are taking a face or head with many capillaries, or if you are taking antithrombotic drugs, bleeding or internal bleeding is particularly likely. Purpura (blue bruise) may occur due to internal bleeding / bleeding, but it usually disappears within 2 to 3 weeks (there are individual differences). Even if internal bleeding or purpura (blue bruise) occurs, we can not guarantee any disadvantages (work suspension, mental distress, etc.) during that time.
Moxibustion gives the skin heat above body temperature. Although extreme care is taken not to cause side effects (burns) due to heat, it may occur in rare cases depending on the constitution or skin condition.

◆　About reactions after treatment
There are individual differences in the reversal response depending on the constitution, but there may feel fatigue, drowsiness, and a reaction that makes you feel hot (this is a temporary symptom, so there is no undue worry).
After treatment, you may feel that the problem you are experiencing is temporarily strengthened (don't worry because it is considered as part of the body's recovery process).

If you wish to take acupuncture and moxibustion, please understand that you understand the above and consent to receive the procedure.

◆　About Aroma massage
Please note that our aroma massage is not a medical treatment. Massage will be done in agreement with the therapist. We are not responsible for any symptoms during or after the massage.
In addition, please confirm that person who applies to the next item may not receive treatment.

・Athlete's foot, inflammation, contagious skin disease, person with infection.
・Disease associated with heart, brain and blood vessels (severe varicose veins, etc.)
・Fever, or poor physical condition
・Severe diabetes, osteoporosis
・Alcohol intake ・Those who have just been after meals
・Severe sunburn ・Severe atopic dermatitis
・Beauty treatment (collagen, botox, hair loss) within 2 weeks .
・Those who have just undergone plastic surgery, drip, chemical peeling, etc. at cosmetic surgery
・Those who have opened tattoos, art makeup, and piercings within 3 months
・Those who have just done face shaving, tweezers, peeling

Please read the above confirmation items and understand that you can receive treatment after understanding.