Dear Patient:
At the bottom of this page are history, financial policy, and medical consent (release) forms for both my
Bethesda, MD, and Bala Cynwyd, PA, offices. Please read and sign the forms for the location you will be visiting and bring them for your first visit. The consent form is for your information and will be signed in the presence of the doctor. This will enable you to ask questions you might have.
Please note the following:
- Discuss with your primary care and/or treating physician the role of acupuncture as an adjunct to your current conventional treatment. Make sure your condition has been accurately diagnosed. Please submit the medical release form to your primary care/treating physician.
- Bring the following information with you on your first visit:
a. Copies of your medical records
b. A list of prescription drugs or medicines you are currently taking
c. Medical reports of any X-rays/MRIs/CAT scans (summary interpretation – not actual films)
d. Signed medical release form from your primary care/treating physician
- Inform the doctor if you are pregnant, have a pacemaker, suffer from a bleeding disorder, or are currently taking any anti-coagulant medicines.
- You should allow 1 1/2 hours for the initial visit and 45 minutes for each subsequent visit. Acupuncture requires approximately 20-30 minutes, plus 10 minutes resting time after each treatment.
- We recommend that you abstain from the following activities 10-12 hours after each treatment:
a. Exercise or vigorous activities
b. Alcohol
c. Sex
d. Heavy foods/meals
- During the course of acupuncture, should your medical condition warrant urgent medical attention, please call your primary care or treating physician. Please remember we cannot serve as your primary care or conventional treating physician.
If you have any questions, please do not hesitate to contact me at 610-256-4103.
Sincerely,

Maximilian Muenke, M.D.
Forms for Maryland Office Patients:
Consent Form
Medical Release Form
Medical History Form
Financial Policy Form
Forms for Pennsylvania Office Patients:
Consent Form
Medical Release Form
Medical History Form
Financial Policy Form