New Patient Registration Form
Lucas Acupuncture
Email *
Disclosure Statement for Martha Lucas, Ph.D. (Psychology), L.Ac.
Dr. Martha Lucas, L.Ac.
1331 Vine Street, Denver and 7780 South Broadway, Suite 100, Littleton
303-947-6224; Email - DrMLucas@AcupunctureWoman.com
Disclosure statement for Martha Lucas, Ph.D. (Psychology), L.Ac.

General Information

Treatment modalities used in this office may include but are not limited to:
  • acupuncture
  • distance relaxation therapy/Telehealth
  • Chinese herbal prescriptions, supplements consult
  • moxibustion/heat therapy
  • gua sha (Chinese medical massage)
  • cosmetic acupuncture
  • trigger point injections for pain
  • microneedling (cosmetic, wrinkle reduction, skin rejuvenation)
  • supercharged oxygen (aka ozone, high activated oxygen) therapy including ear insufflation and “limb bagging” for eczema, psoriasis etc.
  • cold laser/low level light therapy
  • ear acupuncture for quitting smoking and reducing food cravings
Professional Background and current activities: How I got into Chinese medicine
I am a Research Psychologist who started my medical career on the Western
medicine side doing hospital research. During that time, I also studied a variety of “energy
medicines” culminating with my earning my license in Traditional Chinese Medicine. I have
been practicing Chinese medicine for more than 20 years now! My expertise is in diagnosis
and determining a treatment plan that works to address the causes of your condition or
symptom. I am known internationally as an instructor of Chinese medicine where I teach
practitioners how to get better treatment outcomes. Sometimes that’s why I am out of clinic
… I am teaching somewhere in the US or overseas.

Information about fees:
*We are happy to check your insurance coverage; there is a $15 fee to do so. If acupuncture
is covered by your insurance, I will give you a superbill receipt for your treatment payment
that you may send to your insurance carrier for reimbursement.

***Dr. Lucas does not process credit cards but does take Venmo, cash, checks, and payment through Zelle.

FEES:
* Treatments are 45 to 50 minutes long.
Single treatment: $135
Package of 3 treatments: $315 (save $90)
Package of 6 treatments: $594 (save $216)
These package prices do not apply for Cosmetic Acupuncture or Weight Loss packages.
Packages of three expire in 6 months; packages of six expire in 9 months from date of
purchase.
* Pain relief treatments are 20 to 25 minutes long and may include either or a combination of
dry needling (aka trigger point acupuncture) and/or gua sha medical massage. $65.
* Distance treatment/Telehealth (working together via the phone for Reiki or Relaxation
treatment). $75.
*Payment is due at each appointment.

Cancellation Policy: If you need to cancel an appointment, please call in advance. Full
payment is collected for appointments cancelled with less than 48 hour notice or NO SHOW.

Although immediate relief from symptoms often occurs, acupuncture tends to work in a
cumulative manner. This means that your results improve with each treatment. It takes time
for your body to heal and get back into a healthy balance. Practitioners who tell you they
can “cure you in one treatment” are almost always wrong about that. So I just tell it like it is
right up front. Acute issues may take 4 to 6 treatments while chronic issues can take upwards
of 10 or 12 treatments. 

You have the right to ask for full clarification about any of these procedures before
they are administered to you. Information regarding probable duration of therapy will be
provided where possible. You have the right, at any time, to seek a second opinion from
another health care professional or to terminate therapy at your discretion. I abide by and
comply with all rules and regulations established by the Department of Health and
Environment regarding the practice of acupuncture, cleaning and sterilization of needles, and
sanitation of acupuncture offices. The practice of acupuncture is regulated in Colorado by the
Department of Regulatory Agencies. The address and phone number of the Director of the
Division of Registrations in the Department of Regulatory Agencies is: 1560 Broadway,
Suite 1545, Denver, Colorado 80202. Phone: 303-894-2464.

OTHER SERVICES
  • Mei Zen Cosmetic Acupuncture – Cosmetic Acupuncture Facelift or Neck/Jowl lift is a 10
  • treatment protocol.
  • Short and Sweet Gua Sha facial with hyaluronic complexion water mask
  • Facial Gua Sha Moisture Bomb Treatment
  • Ultrasound Therapy for pain
  • Microneedling/Rejuvapen for wrinkles and improved overall skin
  • CBD Gua Sha pain therapy
  • Tok Sen tapping massage

Injection menu:
  • B12
  • Scar therapy injections
  • Trigger point injections for pain
  • Supercharged Oxygen Therapy (aka Ozone Therapy)
  • Ear insufflation to treat brain fog, ear infections, tinnitus, and generally recharge or oxygenate. Only available in the Denver location.
  • Eczema, psoriasis, or other skin condition treatment - this is a series of treatments in
    order to completely treat the condition. 3 or 4 treatments/week recommended.
Date: *
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Patient Digital Signature (First & Last Name):
*
My digital signature below is acknowledgement that I have read this document and consent to
the performance of acupuncture and other Chinese Medicine treatments as well as
understanding that I will be charged $99 for late cancellation of an appointment or no
advance notice before not keeping an appointment (“no show”). I do not expect Martha
Lucas to be able to anticipate and explain all risks and complications and I wish to rely
on her to exercise judgment based upon the facts known during the course of the
treatment.
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