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, p.a Consent form By signing below, I do hereby voluntarily consent to be treated with acupuncture and/or substances from the Oriental Material Media by a licensed acupuncture Physician. Acupuncture/Combustion:

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Kaitlin Leonard MSOM LAC refers to a licensed acupuncturist and practitioner of traditional Chinese medicine, with a Master of Science in Oriental Medicine (MSOM).

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Information typically required includes personal identification details, professional credentials, practice location, patient care practices, and any continuing education credits.

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