Steven Booth Transpersonal Acupuncture

Community Acupuncture

at Open Sky Wellbeing, Mullumbimby

New client form · about 4 minutes

Welcome

Community acupuncture is a simple, affordable way to receive regular acupuncture. Here’s what to expect.

A shared, quiet room

Several people are treated at the same time, each resting on their own table in a calm, shared space. Conversation is kept low so everyone can settle.

Stay fully clothed

Needles are placed mostly in the arms, lower legs, head and ears. Loose clothing that rolls up past the elbow and knee is ideal.

Rest for around 40 minutes

After a short check-in, you rest with the needles in. Many people doze off. Steven checks in during the session and removes the needles at the end.

Designed for regular visits

The lower price and shorter check-in make it easier to come regularly if you choose to.

When Tuesdays & ThursdaysWhere 1st Floor, 63 Stuart St, Mullumbimby NSW 2482Session 40 minutes

Before you come

Your practitioner is Steven Allan Booth, Qualified Acupuncture Practitioner. Everything you share here is confidential.

01Your details

So Steven can reach you, and someone else if needed.

Street, suburb and postcode

Emergency contact

02What brings you in

A few lines is plenty. Steven will ask more at your check-in.

e.g. 3 months ago, after a fall, gradually over years

How much is this bothering you right now?
0 · not at all10 · as bad as it gets
How well are you sleeping?
0 · very poorly10 · very well
How stressed do you feel?
0 · calm10 · extremely stressed

Write 'none' if none

e.g. latex, adhesive tape, alcohol swabs

Have you had acupuncture before?

03Safety check

A ‘yes’ doesn’t usually rule you out. It helps Steven choose points and needle gently. Do any of these apply to you?

Pregnant, or possibly pregnant
Taking blood-thinning medication (e.g. warfarin, apixaban, aspirin daily)
Bleeding or clotting disorder (e.g. haemophilia)
Pacemaker or other implanted electrical device
Epilepsy or a history of seizures
Diabetes
A heart condition
Have fainted or felt faint with needles, injections or blood tests
An infection, open wound or skin condition on the arms, legs, head or ears
Surgery in the last 6 weeks
Currently having treatment for cancer
A weakened immune system (condition or medication)

04Consent & privacy

Please read, then tick to agree.

  • I understand acupuncture involves inserting fine, sterile, single-use needles into the skin.
  • Common and usually mild after-effects include slight bleeding or bruising at needle sites, temporary soreness, tiredness or light-headedness. Fainting is uncommon. Serious complications, such as infection or injury to underlying structures, are rare.
  • I understand this is a community session: other clients will be in the same room, treatment is given while I'm fully clothed, and the check-in is brief.
  • Acupuncture does not replace medical care. I will keep seeing my doctor for diagnosis and treatment of any medical condition, and I will not stop any prescribed medication without talking to my doctor.
  • I have answered the health questions truthfully and will let Steven know if anything changes.
  • I can ask questions at any time, and I can decline or stop treatment at any point.

Your information is used to provide safe care, keep your clinical record and contact you about your appointments. It is kept confidential and handled under the NSW Health Records and Information Privacy Act 2002 and the Privacy Act 1988 (Cth).

Read the full privacy notice

What we collect and why

Your contact details, emergency contact, and the health information you give on this form and during treatment. We collect it to assess whether acupuncture is suitable for you, to treat you safely, to keep a clinical record, and to contact you about your care.

Where it is stored

Form responses are stored in an encrypted database hosted in Sydney, Australia. A short summary (your name, contact details, date of birth, visit date and a brief health summary) is kept in Steven's private client record in Google Sheets, which may be stored overseas. Emails to you are sent through Resend, an email delivery service based in the United States.

Who sees it

Only Steven Allan Booth. Your health information is not shared with Open Sky Wellbeing staff. We will not disclose it to anyone else without your consent unless the law requires or permits it, for example in an emergency or to prevent a serious threat to someone's health or safety.

Emails

If you tick the box to receive emails, only your first name and email address are added to our mailing list (Kit, based in the United States). You can unsubscribe at any time from any email. Your health information is never added to the mailing list.

How long we keep it

NSW law requires health records to be kept for at least 7 years from your last visit, or until you turn 25 if you were under 18 when the information was collected. After that, records are securely deleted.

Access, corrections and complaints

You can ask to see or correct your information at any time by emailing communityacupuncture@stevenboothacupuncture.com.au. If you have a privacy concern, please contact Steven first. You can also contact the NSW Information and Privacy Commission (ipc.nsw.gov.au) or the Office of the Australian Information Commissioner (oaic.gov.au). Concerns about treatment can be raised with the NSW Health Care Complaints Commission (hccc.nsw.gov.au).

Signed 28 September 2026

05Stay in touch

Steven Booth Transpersonal Acupuncture · 0427 111 460 · communityacupuncture@stevenboothacupuncture.com.au