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Liability Waiver

Liability Waiver for Acupuncturists in California

Secure your California acupuncture practice with a specialized liability waiver. Compliance with Cal-OSHA, AB5, and State Acupuncture Board standards.

By The PaperForge Editorial Team·Last updated June 8, 2026
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In California, acupuncture practitioners face unique risks ranging from needle-stick liability to strict regulatory oversight by the California Acupuncture Board. A standard waiver isn't enough; you... Read more

Customize your Liability Waiver

12 fields · Takes about 2 minutes

Parties
Activity

Include location, duration, and known risks.

Acknowledgment
Emergency
Signatures
Practitioner Information
Treatment Intake

Patient must disclose pregnancy, pacemakers, or bleeding disorders (e.g., Hemophilia) prior to needle insertion.

Scope of Services

Check this if the session includes Chinese herbal medicine recommendations.

Medical Authorization

Liability Waiver and Release of Claims

Legal Document

This Liability Waiver and Release of Claims (this "Waiver") is made and entered into as of [date] by and between [company_name] (the "Released Party"), including its officers, directors, employees, agents, representatives, successors, and assigns, and [participant_name] (the "Participant"). In consideration of the Participant being permitted to participate in the activities described herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Participant agrees as follows:

1. Assumption of Risk

The Participant hereby acknowledges and agrees that participation in the following activity or activities provided by [company_name]: [activity_description] (collectively, the "Activities"), involves inherent risks, dangers, and hazards that may result in serious personal injury, permanent disability, paralysis, death, or property damage or loss. Such risks include, but are not limited to: physical exertion and strain; contact with other participants, equipment, surfaces, or natural features; adverse weather conditions; equipment failure or malfunction; inadequate or negligent instruction or supervision; the negligence of other participants or third parties; and any other risks inherent in or arising from the Activities, whether or not specifically identified herein. THE PARTICIPANT HEREBY EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISKS OF INJURY, ILLNESS, DAMAGE, OR LOSS ARISING FROM OR RELATED TO THE ACTIVITIES, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTY OR OTHERWISE, AND WHETHER SUCH RISKS ARE KNOWN OR UNKNOWN, FORESEEABLE OR UNFORESEEABLE, AT THE TIME OF EXECUTION OF THIS WAIVER. The Participant acknowledges that the Participant has had a full and adequate opportunity to review and consider the nature of the Activities and the risks described herein, and the Participant's assumption of risk is made knowingly, voluntarily, and without coercion or duress of any kind.

2. Waiver and Release of Claims

In consideration of being permitted to participate in the Activities, the Participant, on behalf of the Participant and the Participant's heirs, executors, administrators, personal representatives, assignees, and next of kin, hereby FOREVER RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE [company_name], its officers, directors, employees, agents, representatives, volunteers, affiliates, subsidiaries, parent companies, successors, and assigns (collectively, the "Released Parties") from and against any and all claims, demands, actions, causes of action, suits, liabilities, obligations, damages, losses, costs, expenses (including reasonable attorneys' fees), and judgments of every kind and nature whatsoever, whether known or unknown, suspected or unsuspected, fixed or contingent, that the Participant now has, has ever had, or may hereafter have against the Released Parties, arising out of, connected with, or in any way related to the Participant's participation in the Activities, including but not limited to claims arising from the negligence (whether active or passive), gross negligence, or willful misconduct of the Released Parties, or from any defect or dangerous condition of the premises, facilities, or equipment used in connection with the Activities (collectively, the "Released Claims"). This release is intended to be as broad and inclusive as permitted by applicable law.

3. Indemnification and Hold Harmless

The Participant agrees to INDEMNIFY, DEFEND, AND HOLD HARMLESS [company_name] and the Released Parties from and against any and all claims, demands, actions, causes of action, suits, liabilities, obligations, damages, losses, costs, and expenses (including reasonable attorneys' fees and court costs) brought by or on behalf of the Participant, the Participant's heirs, executors, administrators, personal representatives, assignees, next of kin, or any third party, arising out of, connected with, or in any way related to the Participant's participation in the Activities, including but not limited to any claims arising from the Participant's own negligence, breach of this Waiver, or violation of any applicable law, rule, or regulation. This indemnification obligation shall survive the termination or expiration of this Waiver.

4. Medical Authorization

The Participant hereby authorizes [company_name] and its employees, agents, and representatives to obtain or provide emergency medical treatment for the Participant in the event of an injury, illness, or medical emergency arising during or in connection with the Participant's participation in the Activities, including but not limited to first aid, CPR, transportation to a medical facility, and any other emergency medical care deemed necessary by medical professionals or by [company_name] personnel. The Participant acknowledges and agrees that the Participant shall be solely responsible for all costs, fees, and expenses associated with any such medical treatment, including emergency transportation, hospitalization, surgery, and any follow-up care. The Participant releases the Released Parties from any and all liability arising from the provision of, or failure to provide, emergency medical treatment.

5. Acknowledgment of Understanding

The Participant hereby acknowledges and represents that: (a) the Participant has carefully read this Waiver in its entirety and fully understands its terms and conditions; (b) the Participant is aware that this Waiver constitutes a legally binding contract and a complete release of all liability owed to the Participant by the Released Parties; (c) the Participant has signed this Waiver freely, voluntarily, and without coercion, duress, or undue influence of any kind; (d) the Participant is at least eighteen (18) years of age and is legally competent to enter into this Waiver; (e) the Participant has had the opportunity to consult with legal counsel of the Participant's choosing before executing this Waiver and has either done so or has voluntarily elected not to do so; (f) no oral representations, statements, promises, or inducements apart from the terms set forth in this Waiver have been made to the Participant; and (g) the Participant intends this Waiver to be a complete and unconditional release of all liability to the greatest extent permitted by applicable law.

6. Governing Law

This Waiver shall be governed by, construed, and enforced in accordance with the laws of the state in which [company_name] maintains its principal place of business, without regard to any conflict of laws principles that would require the application of the law of any other jurisdiction. In the event that any dispute arises under or in connection with this Waiver, the Participant irrevocably consents to the exclusive jurisdiction and venue of the state and federal courts located in the jurisdiction of [company_name]'s principal place of business, and the Participant hereby waives any objection to such jurisdiction or venue, including any objection based on inconvenient forum. If any provision of this Waiver is held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other provision of this Waiver, and the remaining provisions shall continue in full force and effect. This Waiver constitutes the entire agreement between [company_name] and the Participant with respect to the subject matter hereof and supersedes all prior or contemporaneous agreements, understandings, and representations, whether written or oral.

Additional Provisions

Informed Consent and Clinical Risks

The Patient acknowledges that acupuncture involves the insertion of sterile, single-use, FDA-regulated needles through the skin at specific points. The Patient understands that risks include, but are not limited to, temporary bruising, localized swelling, needle sickness, fainting, and in rare cases, pneumothorax. By signing this document, the Patient confirms that they have been informed of these specific clinical risks and acknowledges that the Practitioner operates in compliance with Cal-OSHA infection control standards and the California Acupuncture Board's hygienic protocols.

California Civil Code Section 1542 Waiver

The Patient expressly waives all rights under California Civil Code Section 1542, which states: 'A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.' The Patient intends to release all claims, whether currently known or unknown, arising from the acupuncture treatment and herbal consultation.

Notice of Independent Contractor Status (AB5 Compliance)

If the Treatment is administered by an independent contractor at this facility, the Patient acknowledges that such practitioner is an independent entity and not an employee of the clinic, as defined under California Labor Code §§ 2750.3 and the 'ABC Test.' The Patient agrees that any professional liability claims shall be directed solely toward the individual practitioner and their respective insurance policy, and not the facility owner, provided the practitioner maintains a valid license from the California Acupuncture Board.

Additional Details

NCCAOM Certification Number: [practitioner nccaom id]
Relevant Medical History:

[existing medical conditions]

Include Herbal Consultation Consent: No
California License (AC) Number: [california license number]
Preferred Emergency Facility: [emergency care facility]

BY SIGNING BELOW, THE PARTICIPANT ACKNOWLEDGES THAT THE PARTICIPANT HAS READ THIS WAIVER, FULLY UNDERSTANDS ITS TERMS, UNDERSTANDS THAT THE PARTICIPANT HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGNS IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Participant

Name: Participant

Date: ___________________

Liability Waiver and Release of Claims

Legal Document

This Liability Waiver and Release of Claims (this "Waiver") is made and entered into as of [date] by and between [company_name] (the "Released Party"), including its officers, directors, employees, agents, representatives, successors, and assigns, and [participant_name] (the "Participant"). In consideration of the Participant being permitted to participate in the activities described herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Participant agrees as follows:

1. Assumption of Risk

The Participant hereby acknowledges and agrees that participation in the following activity or activities provided by [company_name]: [activity_description] (collectively, the "Activities"), involves inherent risks, dangers, and hazards that may result in serious personal injury, permanent disability, paralysis, death, or property damage or loss. Such risks include, but are not limited to: physical exertion and strain; contact with other participants, equipment, surfaces, or natural features; adverse weather conditions; equipment failure or malfunction; inadequate or negligent instruction or supervision; the negligence of other participants or third parties; and any other risks inherent in or arising from the Activities, whether or not specifically identified herein. THE PARTICIPANT HEREBY EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISKS OF INJURY, ILLNESS, DAMAGE, OR LOSS ARISING FROM OR RELATED TO THE ACTIVITIES, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTY OR OTHERWISE, AND WHETHER SUCH RISKS ARE KNOWN OR UNKNOWN, FORESEEABLE OR UNFORESEEABLE, AT THE TIME OF EXECUTION OF THIS WAIVER. The Participant acknowledges that the Participant has had a full and adequate opportunity to review and consider the nature of the Activities and the risks described herein, and the Participant's assumption of risk is made knowingly, voluntarily, and without coercion or duress of any kind.

2. Waiver and Release of Claims

In consideration of being permitted to participate in the Activities, the Participant, on behalf of the Participant and the Participant's heirs, executors, administrators, personal representatives, assignees, and next of kin, hereby FOREVER RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE [company_name], its officers, directors, employees, agents, representatives, volunteers, affiliates, subsidiaries, parent companies, successors, and assigns (collectively, the "Released Parties") from and against any and all claims, demands, actions, causes of action, suits, liabilities, obligations, damages, losses, costs, expenses (including reasonable attorneys' fees), and judgments of every kind and nature whatsoever, whether known or unknown, suspected or unsuspected, fixed or contingent, that the Participant now has, has ever had, or may hereafter have against the Released Parties, arising out of, connected with, or in any way related to the Participant's participation in the Activities, including but not limited to claims arising from the negligence (whether active or passive), gross negligence, or willful misconduct of the Released Parties, or from any defect or dangerous condition of the premises, facilities, or equipment used in connection with the Activities (collectively, the "Released Claims"). This release is intended to be as broad and inclusive as permitted by applicable law.

3. Indemnification and Hold Harmless

The Participant agrees to INDEMNIFY, DEFEND, AND HOLD HARMLESS [company_name] and the Released Parties from and against any and all claims, demands, actions, causes of action, suits, liabilities, obligations, damages, losses, costs, and expenses (including reasonable attorneys' fees and court costs) brought by or on behalf of the Participant, the Participant's heirs, executors, administrators, personal representatives, assignees, next of kin, or any third party, arising out of, connected with, or in any way related to the Participant's participation in the Activities, including but not limited to any claims arising from the Participant's own negligence, breach of this Waiver, or violation of any applicable law, rule, or regulation. This indemnification obligation shall survive the termination or expiration of this Waiver.

4. Medical Authorization

The Participant hereby authorizes [company_name] and its employees, agents, and representatives to obtain or provide emergency medical treatment for the Participant in the event of an injury, illness, or medical emergency arising during or in connection with the Participant's participation in the Activities, including but not limited to first aid, CPR, transportation to a medical facility, and any other emergency medical care deemed necessary by medical professionals or by [company_name] personnel. The Participant acknowledges and agrees that the Participant shall be solely responsible for all costs, fees, and expenses associated with any such medical treatment, including emergency transportation, hospitalization, surgery, and any follow-up care. The Participant releases the Released Parties from any and all liability arising from the provision of, or failure to provide, emergency medical treatment.

5. Acknowledgment of Understanding

The Participant hereby acknowledges and represents that: (a) the Participant has carefully read this Waiver in its entirety and fully understands its terms and conditions; (b) the Participant is aware that this Waiver constitutes a legally binding contract and a complete release of all liability owed to the Participant by the Released Parties; (c) the Participant has signed this Waiver freely, voluntarily, and without coercion, duress, or undue influence of any kind; (d) the Participant is at least eighteen (18) years of age and is legally competent to enter into this Waiver; (e) the Participant has had the opportunity to consult with legal counsel of the Participant's choosing before executing this Waiver and has either done so or has voluntarily elected not to do so; (f) no oral representations, statements, promises, or inducements apart from the terms set forth in this Waiver have been made to the Participant; and (g) the Participant intends this Waiver to be a complete and unconditional release of all liability to the greatest extent permitted by applicable law.

6. Governing Law

This Waiver shall be governed by, construed, and enforced in accordance with the laws of the state in which [company_name] maintains its principal place of business, without regard to any conflict of laws principles that would require the application of the law of any other jurisdiction. In the event that any dispute arises under or in connection with this Waiver, the Participant irrevocably consents to the exclusive jurisdiction and venue of the state and federal courts located in the jurisdiction of [company_name]'s principal place of business, and the Participant hereby waives any objection to such jurisdiction or venue, including any objection based on inconvenient forum. If any provision of this Waiver is held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other provision of this Waiver, and the remaining provisions shall continue in full force and effect. This Waiver constitutes the entire agreement between [company_name] and the Participant with respect to the subject matter hereof and supersedes all prior or contemporaneous agreements, understandings, and representations, whether written or oral.

Additional Provisions

Informed Consent and Clinical Risks

The Patient acknowledges that acupuncture involves the insertion of sterile, single-use, FDA-regulated needles through the skin at specific points. The Patient understands that risks include, but are not limited to, temporary bruising, localized swelling, needle sickness, fainting, and in rare cases, pneumothorax. By signing this document, the Patient confirms that they have been informed of these specific clinical risks and acknowledges that the Practitioner operates in compliance with Cal-OSHA infection control standards and the California Acupuncture Board's hygienic protocols.

California Civil Code Section 1542 Waiver

The Patient expressly waives all rights under California Civil Code Section 1542, which states: 'A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.' The Patient intends to release all claims, whether currently known or unknown, arising from the acupuncture treatment and herbal consultation.

Notice of Independent Contractor Status (AB5 Compliance)

If the Treatment is administered by an independent contractor at this facility, the Patient acknowledges that such practitioner is an independent entity and not an employee of the clinic, as defined under California Labor Code §§ 2750.3 and the 'ABC Test.' The Patient agrees that any professional liability claims shall be directed solely toward the individual practitioner and their respective insurance policy, and not the facility owner, provided the practitioner maintains a valid license from the California Acupuncture Board.

Additional Details

NCCAOM Certification Number: [practitioner nccaom id]
Relevant Medical History:

[existing medical conditions]

Include Herbal Consultation Consent: No
California License (AC) Number: [california license number]
Preferred Emergency Facility: [emergency care facility]

BY SIGNING BELOW, THE PARTICIPANT ACKNOWLEDGES THAT THE PARTICIPANT HAS READ THIS WAIVER, FULLY UNDERSTANDS ITS TERMS, UNDERSTANDS THAT THE PARTICIPANT HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGNS IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Participant

Name: Participant

Date: ___________________

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Customize your Liability Waiver

12 fields · Takes about 2 minutes

Parties
Activity

Include location, duration, and known risks.

Acknowledgment
Emergency
Signatures
Practitioner Information
Treatment Intake

Patient must disclose pregnancy, pacemakers, or bleeding disorders (e.g., Hemophilia) prior to needle insertion.

Scope of Services

Check this if the session includes Chinese herbal medicine recommendations.

Medical Authorization

Liability Waiver and Release of Claims

Legal Document

This Liability Waiver and Release of Claims (this "Waiver") is made and entered into as of [date] by and between [company_name] (the "Released Party"), including its officers, directors, employees, agents, representatives, successors, and assigns, and [participant_name] (the "Participant"). In consideration of the Participant being permitted to participate in the activities described herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Participant agrees as follows:

1. Assumption of Risk

The Participant hereby acknowledges and agrees that participation in the following activity or activities provided by [company_name]: [activity_description] (collectively, the "Activities"), involves inherent risks, dangers, and hazards that may result in serious personal injury, permanent disability, paralysis, death, or property damage or loss. Such risks include, but are not limited to: physical exertion and strain; contact with other participants, equipment, surfaces, or natural features; adverse weather conditions; equipment failure or malfunction; inadequate or negligent instruction or supervision; the negligence of other participants or third parties; and any other risks inherent in or arising from the Activities, whether or not specifically identified herein. THE PARTICIPANT HEREBY EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISKS OF INJURY, ILLNESS, DAMAGE, OR LOSS ARISING FROM OR RELATED TO THE ACTIVITIES, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTY OR OTHERWISE, AND WHETHER SUCH RISKS ARE KNOWN OR UNKNOWN, FORESEEABLE OR UNFORESEEABLE, AT THE TIME OF EXECUTION OF THIS WAIVER. The Participant acknowledges that the Participant has had a full and adequate opportunity to review and consider the nature of the Activities and the risks described herein, and the Participant's assumption of risk is made knowingly, voluntarily, and without coercion or duress of any kind.

2. Waiver and Release of Claims

In consideration of being permitted to participate in the Activities, the Participant, on behalf of the Participant and the Participant's heirs, executors, administrators, personal representatives, assignees, and next of kin, hereby FOREVER RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE [company_name], its officers, directors, employees, agents, representatives, volunteers, affiliates, subsidiaries, parent companies, successors, and assigns (collectively, the "Released Parties") from and against any and all claims, demands, actions, causes of action, suits, liabilities, obligations, damages, losses, costs, expenses (including reasonable attorneys' fees), and judgments of every kind and nature whatsoever, whether known or unknown, suspected or unsuspected, fixed or contingent, that the Participant now has, has ever had, or may hereafter have against the Released Parties, arising out of, connected with, or in any way related to the Participant's participation in the Activities, including but not limited to claims arising from the negligence (whether active or passive), gross negligence, or willful misconduct of the Released Parties, or from any defect or dangerous condition of the premises, facilities, or equipment used in connection with the Activities (collectively, the "Released Claims"). This release is intended to be as broad and inclusive as permitted by applicable law.

3. Indemnification and Hold Harmless

The Participant agrees to INDEMNIFY, DEFEND, AND HOLD HARMLESS [company_name] and the Released Parties from and against any and all claims, demands, actions, causes of action, suits, liabilities, obligations, damages, losses, costs, and expenses (including reasonable attorneys' fees and court costs) brought by or on behalf of the Participant, the Participant's heirs, executors, administrators, personal representatives, assignees, next of kin, or any third party, arising out of, connected with, or in any way related to the Participant's participation in the Activities, including but not limited to any claims arising from the Participant's own negligence, breach of this Waiver, or violation of any applicable law, rule, or regulation. This indemnification obligation shall survive the termination or expiration of this Waiver.

4. Medical Authorization

The Participant hereby authorizes [company_name] and its employees, agents, and representatives to obtain or provide emergency medical treatment for the Participant in the event of an injury, illness, or medical emergency arising during or in connection with the Participant's participation in the Activities, including but not limited to first aid, CPR, transportation to a medical facility, and any other emergency medical care deemed necessary by medical professionals or by [company_name] personnel. The Participant acknowledges and agrees that the Participant shall be solely responsible for all costs, fees, and expenses associated with any such medical treatment, including emergency transportation, hospitalization, surgery, and any follow-up care. The Participant releases the Released Parties from any and all liability arising from the provision of, or failure to provide, emergency medical treatment.

5. Acknowledgment of Understanding

The Participant hereby acknowledges and represents that: (a) the Participant has carefully read this Waiver in its entirety and fully understands its terms and conditions; (b) the Participant is aware that this Waiver constitutes a legally binding contract and a complete release of all liability owed to the Participant by the Released Parties; (c) the Participant has signed this Waiver freely, voluntarily, and without coercion, duress, or undue influence of any kind; (d) the Participant is at least eighteen (18) years of age and is legally competent to enter into this Waiver; (e) the Participant has had the opportunity to consult with legal counsel of the Participant's choosing before executing this Waiver and has either done so or has voluntarily elected not to do so; (f) no oral representations, statements, promises, or inducements apart from the terms set forth in this Waiver have been made to the Participant; and (g) the Participant intends this Waiver to be a complete and unconditional release of all liability to the greatest extent permitted by applicable law.

6. Governing Law

This Waiver shall be governed by, construed, and enforced in accordance with the laws of the state in which [company_name] maintains its principal place of business, without regard to any conflict of laws principles that would require the application of the law of any other jurisdiction. In the event that any dispute arises under or in connection with this Waiver, the Participant irrevocably consents to the exclusive jurisdiction and venue of the state and federal courts located in the jurisdiction of [company_name]'s principal place of business, and the Participant hereby waives any objection to such jurisdiction or venue, including any objection based on inconvenient forum. If any provision of this Waiver is held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other provision of this Waiver, and the remaining provisions shall continue in full force and effect. This Waiver constitutes the entire agreement between [company_name] and the Participant with respect to the subject matter hereof and supersedes all prior or contemporaneous agreements, understandings, and representations, whether written or oral.

Additional Provisions

Informed Consent and Clinical Risks

The Patient acknowledges that acupuncture involves the insertion of sterile, single-use, FDA-regulated needles through the skin at specific points. The Patient understands that risks include, but are not limited to, temporary bruising, localized swelling, needle sickness, fainting, and in rare cases, pneumothorax. By signing this document, the Patient confirms that they have been informed of these specific clinical risks and acknowledges that the Practitioner operates in compliance with Cal-OSHA infection control standards and the California Acupuncture Board's hygienic protocols.

California Civil Code Section 1542 Waiver

The Patient expressly waives all rights under California Civil Code Section 1542, which states: 'A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.' The Patient intends to release all claims, whether currently known or unknown, arising from the acupuncture treatment and herbal consultation.

Notice of Independent Contractor Status (AB5 Compliance)

If the Treatment is administered by an independent contractor at this facility, the Patient acknowledges that such practitioner is an independent entity and not an employee of the clinic, as defined under California Labor Code §§ 2750.3 and the 'ABC Test.' The Patient agrees that any professional liability claims shall be directed solely toward the individual practitioner and their respective insurance policy, and not the facility owner, provided the practitioner maintains a valid license from the California Acupuncture Board.

Additional Details

NCCAOM Certification Number: [practitioner nccaom id]
Relevant Medical History:

[existing medical conditions]

Include Herbal Consultation Consent: No
California License (AC) Number: [california license number]
Preferred Emergency Facility: [emergency care facility]

BY SIGNING BELOW, THE PARTICIPANT ACKNOWLEDGES THAT THE PARTICIPANT HAS READ THIS WAIVER, FULLY UNDERSTANDS ITS TERMS, UNDERSTANDS THAT THE PARTICIPANT HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGNS IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Participant

Name: Participant

Date: ___________________

Liability Waiver and Release of Claims

Legal Document

This Liability Waiver and Release of Claims (this "Waiver") is made and entered into as of [date] by and between [company_name] (the "Released Party"), including its officers, directors, employees, agents, representatives, successors, and assigns, and [participant_name] (the "Participant"). In consideration of the Participant being permitted to participate in the activities described herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Participant agrees as follows:

1. Assumption of Risk

The Participant hereby acknowledges and agrees that participation in the following activity or activities provided by [company_name]: [activity_description] (collectively, the "Activities"), involves inherent risks, dangers, and hazards that may result in serious personal injury, permanent disability, paralysis, death, or property damage or loss. Such risks include, but are not limited to: physical exertion and strain; contact with other participants, equipment, surfaces, or natural features; adverse weather conditions; equipment failure or malfunction; inadequate or negligent instruction or supervision; the negligence of other participants or third parties; and any other risks inherent in or arising from the Activities, whether or not specifically identified herein. THE PARTICIPANT HEREBY EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISKS OF INJURY, ILLNESS, DAMAGE, OR LOSS ARISING FROM OR RELATED TO THE ACTIVITIES, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTY OR OTHERWISE, AND WHETHER SUCH RISKS ARE KNOWN OR UNKNOWN, FORESEEABLE OR UNFORESEEABLE, AT THE TIME OF EXECUTION OF THIS WAIVER. The Participant acknowledges that the Participant has had a full and adequate opportunity to review and consider the nature of the Activities and the risks described herein, and the Participant's assumption of risk is made knowingly, voluntarily, and without coercion or duress of any kind.

2. Waiver and Release of Claims

In consideration of being permitted to participate in the Activities, the Participant, on behalf of the Participant and the Participant's heirs, executors, administrators, personal representatives, assignees, and next of kin, hereby FOREVER RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE [company_name], its officers, directors, employees, agents, representatives, volunteers, affiliates, subsidiaries, parent companies, successors, and assigns (collectively, the "Released Parties") from and against any and all claims, demands, actions, causes of action, suits, liabilities, obligations, damages, losses, costs, expenses (including reasonable attorneys' fees), and judgments of every kind and nature whatsoever, whether known or unknown, suspected or unsuspected, fixed or contingent, that the Participant now has, has ever had, or may hereafter have against the Released Parties, arising out of, connected with, or in any way related to the Participant's participation in the Activities, including but not limited to claims arising from the negligence (whether active or passive), gross negligence, or willful misconduct of the Released Parties, or from any defect or dangerous condition of the premises, facilities, or equipment used in connection with the Activities (collectively, the "Released Claims"). This release is intended to be as broad and inclusive as permitted by applicable law.

3. Indemnification and Hold Harmless

The Participant agrees to INDEMNIFY, DEFEND, AND HOLD HARMLESS [company_name] and the Released Parties from and against any and all claims, demands, actions, causes of action, suits, liabilities, obligations, damages, losses, costs, and expenses (including reasonable attorneys' fees and court costs) brought by or on behalf of the Participant, the Participant's heirs, executors, administrators, personal representatives, assignees, next of kin, or any third party, arising out of, connected with, or in any way related to the Participant's participation in the Activities, including but not limited to any claims arising from the Participant's own negligence, breach of this Waiver, or violation of any applicable law, rule, or regulation. This indemnification obligation shall survive the termination or expiration of this Waiver.

4. Medical Authorization

The Participant hereby authorizes [company_name] and its employees, agents, and representatives to obtain or provide emergency medical treatment for the Participant in the event of an injury, illness, or medical emergency arising during or in connection with the Participant's participation in the Activities, including but not limited to first aid, CPR, transportation to a medical facility, and any other emergency medical care deemed necessary by medical professionals or by [company_name] personnel. The Participant acknowledges and agrees that the Participant shall be solely responsible for all costs, fees, and expenses associated with any such medical treatment, including emergency transportation, hospitalization, surgery, and any follow-up care. The Participant releases the Released Parties from any and all liability arising from the provision of, or failure to provide, emergency medical treatment.

5. Acknowledgment of Understanding

The Participant hereby acknowledges and represents that: (a) the Participant has carefully read this Waiver in its entirety and fully understands its terms and conditions; (b) the Participant is aware that this Waiver constitutes a legally binding contract and a complete release of all liability owed to the Participant by the Released Parties; (c) the Participant has signed this Waiver freely, voluntarily, and without coercion, duress, or undue influence of any kind; (d) the Participant is at least eighteen (18) years of age and is legally competent to enter into this Waiver; (e) the Participant has had the opportunity to consult with legal counsel of the Participant's choosing before executing this Waiver and has either done so or has voluntarily elected not to do so; (f) no oral representations, statements, promises, or inducements apart from the terms set forth in this Waiver have been made to the Participant; and (g) the Participant intends this Waiver to be a complete and unconditional release of all liability to the greatest extent permitted by applicable law.

6. Governing Law

This Waiver shall be governed by, construed, and enforced in accordance with the laws of the state in which [company_name] maintains its principal place of business, without regard to any conflict of laws principles that would require the application of the law of any other jurisdiction. In the event that any dispute arises under or in connection with this Waiver, the Participant irrevocably consents to the exclusive jurisdiction and venue of the state and federal courts located in the jurisdiction of [company_name]'s principal place of business, and the Participant hereby waives any objection to such jurisdiction or venue, including any objection based on inconvenient forum. If any provision of this Waiver is held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other provision of this Waiver, and the remaining provisions shall continue in full force and effect. This Waiver constitutes the entire agreement between [company_name] and the Participant with respect to the subject matter hereof and supersedes all prior or contemporaneous agreements, understandings, and representations, whether written or oral.

Additional Provisions

Informed Consent and Clinical Risks

The Patient acknowledges that acupuncture involves the insertion of sterile, single-use, FDA-regulated needles through the skin at specific points. The Patient understands that risks include, but are not limited to, temporary bruising, localized swelling, needle sickness, fainting, and in rare cases, pneumothorax. By signing this document, the Patient confirms that they have been informed of these specific clinical risks and acknowledges that the Practitioner operates in compliance with Cal-OSHA infection control standards and the California Acupuncture Board's hygienic protocols.

California Civil Code Section 1542 Waiver

The Patient expressly waives all rights under California Civil Code Section 1542, which states: 'A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.' The Patient intends to release all claims, whether currently known or unknown, arising from the acupuncture treatment and herbal consultation.

Notice of Independent Contractor Status (AB5 Compliance)

If the Treatment is administered by an independent contractor at this facility, the Patient acknowledges that such practitioner is an independent entity and not an employee of the clinic, as defined under California Labor Code §§ 2750.3 and the 'ABC Test.' The Patient agrees that any professional liability claims shall be directed solely toward the individual practitioner and their respective insurance policy, and not the facility owner, provided the practitioner maintains a valid license from the California Acupuncture Board.

Additional Details

NCCAOM Certification Number: [practitioner nccaom id]
Relevant Medical History:

[existing medical conditions]

Include Herbal Consultation Consent: No
California License (AC) Number: [california license number]
Preferred Emergency Facility: [emergency care facility]

BY SIGNING BELOW, THE PARTICIPANT ACKNOWLEDGES THAT THE PARTICIPANT HAS READ THIS WAIVER, FULLY UNDERSTANDS ITS TERMS, UNDERSTANDS THAT THE PARTICIPANT HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGNS IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Participant

Name: Participant

Date: ___________________

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Why You Need This Liability Waiver

In California, acupuncture practitioners face unique risks ranging from needle-stick liability to strict regulatory oversight by the California Acupuncture Board. A standard waiver isn't enough; you need a document that acknowledges the clinical risks of meridian-based treatments, addresses infection control protocols under Cal-OSHA, and satisfies California Civil Code requirements for clear informed consent. Protect your license and your business by clearly defining the scope of practice and securing specific medical authorizations before treatment begins.

Risk Acknowledgment & Liability Limits

What This Waiver Covers

Beyond the standard liability waiver sections, this template adds fields specific to Acupuncturist:

+NCCAOM Certification Number(Practitioner Information)
+Relevant Medical History(Treatment Intake)
+Include Herbal Consultation Consent(Scope of Services)
+California License (AC) Number(Practitioner Information)
+Preferred Emergency Facility(Medical Authorization)

The core legal purpose of a Liability Waiver is to reduce or eliminate the legal liability of an organization or entity by having the participant acknowledge and accept the risks involved in an activity, thereby waiving their right to sue for damages or injuries incurred as a result of their participation.

Liability Risks This Waiver Addresses

Needle injury liability

Informed consent forms should clearly detail the risks of acupuncture, ensuring patients acknowledge potential injuries.

Waiver Law in California

Cal. Civ. Code § 1624 — California's Statute of Frauds requires certain contracts to be in writing, such as those for the sale of goods over $500, and contracts that cannot be completed within one year. This statute mirrors the UCC but differs in certain contexts, such as real estate transactions.
Cal. Civ. Code § 1550 — California requires parties to a contract to have both the capacity to contract and that there must be lawful consideration. The Code highlights certain scenarios that might not traditionally meet these elements under common law.

What Makes a Liability Waiver Enforceable

For this liability waiver to be legally valid:

  • +The document must be signed by the participant or an authorized representative, including electronic signatures where legally permissible.
  • +The waiver should be clearly written and understandable, avoiding legal jargon that may confuse the signatory.
  • +Participants should be given ample opportunity to read and understand the waiver before signing it.
  • +In some states, minors may require the signature of a parent or guardian, and additional language may be necessary to account for this.
  • +Certain jurisdictions may require a witness or notary for the waiver to be enforceable, particularly if it involves high-risk activities.

Common mistakes to avoid:

  • !Failing to adequately describe the risks associated with the activity, resulting in incomplete informed consent.
  • !Using overly broad or ambiguous language that might render the waiver unenforceable under state law.
  • !Not including a clause that specifies the waiver is governed by the laws of a particular state, leading to jurisdictional issues.
  • !Neglecting to ensure that the waiver is signed by the participant, especially when electronic signatures are not validated.
  • !Ignoring the necessity of customizing the waiver for specific activities, resulting in generic terms that may not encompass all potential risks.

California-Specific Provisions to Watch

  • +California Consumer Privacy Act (Cal. Civ. Code § 1798.100 et seq.) affecting business data handling practices.
  • +The California Environmental Quality Act (Cal. Pub. Res. Code §§ 21000 et seq.), impacting business projects and development.
  • +Community property laws influencing marital rights and property division (Cal. Fam. Code § 760).
  • +Mechanics Lien Law (Cal. Civ. Code §§ 8000 et seq.) allowing contractors to secure payment for work done.
  • +Tenant Protections and Rent Control (Cal. Civ. Code § 1946.2) imposing strict regulations on rental increases and evictions.

Regulations Acupuncturist Must Know

Occupational Safety and Health Administration (OSHA) Regulations

These regulations govern the safety and health standards to prevent workplace injuries and infections, which are critical for acupuncturists who handle needles.

Enforced by Occupational Safety and Health Administration (OSHA)

State Acupuncture Board Regulations

Most states have specific acupuncture boards that set standards for practice, including scope of practice, needle use protocols, and continuing education requirements. These vary by state but generally enforce training and safety standards.

Enforced by State Acupuncture Boards

FDA Regulation of Acupuncture Needles

Acupuncture needles are regulated as medical devices to ensure they are sterile, non-toxic, and properly labeled according to FDA standards.

Enforced by U.S. Food and Drug Administration (FDA)

Licensing & Insurance for Acupuncturist

  • +Completion of a degree in acupuncture from an accredited institution
  • +Certification from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)
  • +State-specific acupuncture license, which usually requires passing the NCCAOM exams and completing a certain number of clinical hours

Recommended coverage: Professional Liability Insurance (also known as Malpractice Insurance) · General Liability Insurance · Product Liability Insurance (for herbal products) · Worker's Compensation Insurance (if employing other staff)

Contract Pitfalls Specific to Acupuncturist

  • !Misunderstandings about scope of practice leading to disputes over services rendered
  • !Issues arising from non-standardized informed consent procedures, resulting in patient claims
  • !Disputes over the efficacy of treatment which might not meet patient expectations leading to refund demands

Frequently Asked Questions

01

Does a waiver protect me from California Acupuncture Board disciplinary actions?

No. While a liability waiver helps protect you from civil lawsuits for damages, it does not prevent the California Acupuncture Board from investigating complaints or disciplining practitioners for violations of the Business and Professions Code or scope of practice regulations.

02

How does California Civil Code section 1542 affect my waiver?

In California, general releases typically do not extend to claims which the creditor does not know or suspect to exist. Our waiver includes specific language regarding California Civil Code § 1542 and related statutes to ensure that the patient is making an informed and enforceable release of both known and unknown future claims.

03

Is an electronic signature valid for medical waivers in California?

Yes, under the California Uniform Electronic Transactions Act (UETA), electronic signatures are legally binding for liability waivers provided the patient is given the opportunity to review the document and manifests clear intent to sign it.

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