Bee Venom Therapy
CONSENT FOR APITHERAPY
APITHERAPY is the art and science of making
therapeutic use of products of the honey bee
hive, including honey, pollen, propolis, royal
jelly, bees wax and bee venom. To be most effective
this treatment requires a relationship of trust
and confidence between Apitherapist and the RECIPIENT
of APITHERAPY. Both parties must recognize the
need to cooperate and work together.
I, the RECIPIENT, understand that:
- APITHERAPY is not a procedure approved by
the US Food and Drug Administration, the
American Medical Association, or any other
regulatory agency in the United States.
- APITHERAPY addresses the whole body, including
mind and spirit, in a holistic way.
- There are no clearly established protocols
- Complications of APITHERAPY can include
itching, swelling, bruising, infection,
temporary discomfort and allergic reactions
ranging from skin irritation or rash up
to anaphylactic shock which can cause difficulty
breathing, loss of consciousness and even
death if not treated appropriately.
- The Apitherapist has made no guarantees
or promises of any kind regarding the safety
or efficacy or results of Apitherapy.
- The Apitherapist will take the actions
I believe are reasonable and necessary
to protect the health and safety of the
- Alternatives to APITHERAPY may include surgery,
medication, massage, spinal manipulation, medical
treatment and advice, and a regimen of diet
and exercise. All have been considered or tried
and I have chosen to pursue APITHERAPY for
relieving pain, enhancing wellbeing and/or
improving my physical condition.
I have given the Apitherapist a clear, candid
and complete disclosure of my medical history
including problems, treatments and medications.
I am not on Beta-blockers. Should I begin
to exhibit signs of a significant allergic reaction,
I authorize the Apitherapist to administer
Epinephrine and/or an antihistamine.
The Apitherapist has advised me of the procedure
planned. I have received a clear, comprehensive
explanation of the risks inherent in APITHERAPY
procedures and their possible adverse consequences,
including death. I have discussed these matters
with the Apitherapist, and am satisfied that
the answers have been understandable, thorough
and have adequately addressed my concerns.
I am confident I have the information necessary
to understand the risks and benefits of the
procedure so I may give this informed consent.
I understand that I am entitled to receive a
copy of this consent form when it is executed.
I _____________________________ the Apitherapist, state that I have fully and
frankly explained the risks and benefits of APITHERAPY, and pledge
my best efforts to administer it in a proper
manner based on my training, experience, and best
We, the Apitherapist and RECIPIENT, understand
the cooperative nature of this treatment and
understand our individual and each others
responsibilities. We have read and understood
this document, affirm the statements made above,
and evidence our acceptance of the above terms
by signing below.
Signed this _____ day of _____, 201__
at ___ ____________________
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