Spa Manager’s Guide to

AcupunctureVersion 1.0

Welcome to the world of Chinese Medicine

Your spa is about to embark on a new Far East healing adventure. With the addition of acupuncture and Chinese medicine to your spa, we will now be able to offer a wider array of services for our guests. New and proven treatments for weight loss, sea sickness and pain among others will be incorporated into the spa menu and provide new sources of revenue for you and your spa.

Traditionally, within the spa, there were many symptoms or ailments that could not be addressed and guests were turned away. Now, most all of these can be treated safely and effectively with acupuncture. Our acupuncturists are highly trained and capable of treating a wide variety of health related problems and symptoms, ranging from migraines and headaches to digestive complaints, fatigue and even depression.

You will quickly discover that the addition of acupuncture to your spa will not only increase revenue, but can also be used to help promote other services as well. As part of the patient’s intake, given to all who receive acupuncture, the acupuncturist will refer to other services based on the patient’s needs and goals. Whether the patient needs massage for pain relief, Ionithermie for weight loss and detox, or a facial for better skin appearance, the acupuncturist will be a team player. Given the level of education that each acupuncturist must possess, he/she will be able to “prescribe” other therapies and products to guests in order to reach their desired goals. In addition, properly educating current spa therapists on acupuncture will be the biggest and best way to promote acupuncture form within the spa.

It’s important to remember that the addition of acupuncture to your spa is incremental revenue. That means that when the acupuncturist arrives, your targets will be increased. Remember that I am here to help, provide inspiration and motivation, however ultimately the management and performance of the acupuncturist is your responsibility. Together, I believe that we can make acupuncture as indispensable to the spa industry as massage and facials.

Thank you,

Dan BrownDirector of Oriental Medicine ProgramsSteiner Management Services, LLC

II. Table of Contents

I. Welcome

II. Table of Contents

III. Acupuncturea. What is it? What is it for? What is it like?b. Additional Acupuncture FAQ’sc. Sample Menud. Treatments

i. Sea Sicknessii. Facial Rejuvenation

iii. Weight Loss & Stop Smokinge. Treatment Protocols - samples

i. Facial Rejuvenationii. Pain Management

IV. Acupuncturistsa. Who are they?b. Qualifications/Educational standardsc. Know Your Acupuncturistd. 5 Day Training Schedule

V. Managing the Acupuncture Program a. Rules (dress code, conduct etc.)

b. Safety Rules & Regulations c. Acupuncture Flash

d. Managing Accidents e. Bio-Hazard Containers

f. Biohazard Container Disposal Signature Sheet g. Sanitation Guidelines/ Policy

VI Promotion/Advertisinga. Advertising and Collateralb. Spa Packages/Cross Promotionc. Advertising & Promotion Checklist

VII Miscellaneousa. List of supplies/ Reordersb. glossary

III. Acupuncture

a. General Questions

What is Acupuncture and what does it do? Acupuncture is a traditional Chinese medicine that has been practiced for over 3000 years. It is a small part of a much larger complete system of health care called Traditional Chinese Medicine or TCM. Since making its way west, TCM has quickly become one of the fastest growing alternative therapies and is often used to complement and enhance the benefits of traditional (allopathic) medicine. Acupuncture subscribes to the ancient view that the basis of good health is the harmonious balance of qi (chi), the vital life force that empowers the body and the universe. When the qi can flow freely, health abounds. If this energy becomes stagnant or blocked, symptoms and disease may occur. The acupuncturist’s goal is to release blocked energy by applying sterilized needles to key points on the body to restore balance and improve health. This can be accomplished with acupuncture, herbal medicine, nutrition or lifestyle advice.

What is acupuncture for? Acupuncture treats a wide variety of ailments. For thousands of years, acupuncture has been used to treat just about everything. However, there are many things that acupuncture does very well. We see remarkable success with the treatment of pain. Whether the pain is acute, chronic, mild or severe, acupuncture in most cases can provide temporary if not permanent relief. In addition to treating pain, we are very successful at treating menopausal complaints, digestive issues, insomnia, menstrual issues and sea sickness to name just a few. Each practitioner that boards the ship will have his/her own specialty. While acupuncturists are all adept at treating a variety of conditions, some have chosen to specialize and develop their own treatments protocols for specific conditions.

What is a treatment like? Acupuncture treatments are very relaxing. Most patients fall asleep during a treatment and experience a sense of euphoria after their session. When a guest decides to have acupuncture, they are given an acupuncture intake form to fill out detailing their chief complaint and history of illness. Once completed, they will be interviewed by the practitioner for approximately 20 minutes. Time varies based on chief complaint, patient’s goals and other factors. Patients are then given an explanation of the treatment and are placed face up or down on the table depending on their reason for the visit. Acupuncture points are chosen based on the practitioners Chinese Medical diagnosis. This diagnosis is formulated based on the patient’s presentation and history. Anywhere from six to fifteen needles will be used during treatment. Once the needles are in, the patient is instructed on breathing techniques and is allowed to rest for up to 30 minutes. At the end of the session, the needles are removed and the patient is asked how they feel. At this point, the patients are very relaxed and a prognosis is given. The acupuncturists will prescribe more treatments if needed as well as products, dietary and lifestyle advice. The whole process lasts just under an hour. Follow up treatments are much shorter, ranging anywhere from thirty to forty minutes.

b. Additional Acupuncture FAQ’s

Q: Does acupuncture hurt?

A: No, acupuncture does not hurt. Acupuncture needles are about as thick as a human hair. They are so thin that several acupuncture needles can fit into the middle of a hypodermic needle. While there may be a mild sensation during the insertion of acupuncture needle, this quickly passes. Some people feel nothing at all; others experience a brief moment of discomfort as the needle penetrates the skin. Some experience mild sensations of cramping, tingling, numbness, warmth, or heaviness.

Q: How deep do the needles go?

A: Most acupuncture points are located on or near surface of the skin. Usually needles are inserted from 1/4 to 1 inch in depth. Depth of insertion will depend on the nature of the condition being treated, the patients' size, age, and constitution.

Q: What conditions are treated with acupuncture?

A: Since Traditional Chinese Medicine (TCM) was the only form of treatment available to billions of people for many centuries, it was used to treat all conditions. The following is a partial list of conditions treated: allergies, asthma, arthritis, back pain, bursitis, chronic fatigue, earache, fibroids, diabetes, insomnia, PMS, impotence, IBS, Headache, muscle spasms, nausea, vomiting, stress, tendonitis, menopause, weight control and smoking cessation. These conditions listed have been researched thoroughly and the findings have been published in many medical journals and newspapers.

Q: How many treatments does a person need?

A: The length, number and frequency of treatments will vary. A consultation with an experienced practitioner about you and your condition will offer the best guide for the length of treatment. Typical treatments last 30-60 minutes, with the patient being treated two to three times s a week. Generally acute problems require less time and frequency of treatment. Chronic and severe ailments may require several treatments. Cosmetic acupuncture requires a series of treatments.

Q: How does acupuncture work?

A : Using modern scientific testing equipment the acupuncture channels and individual points can be traced on the body as they are the pathways on the body that have the least resistance to electrical or qi [chi] flow. Technological advancements have made it possible to validate the existence and location of the channels and points. By stimulating specific points on or near the skin surface, acupuncture creates various biochemical and physiological conditions which can correct imbalances. Hormones, chemicals and endorphins are released by the body in response to acupuncture, which is why acupuncture can reduce pain, regulate the endocrine system, and regulate serotonin

levels and can be used to treat back pain, reduce anxiety and stress, help with depression, and PMS, Infertility and Menopause.A classical explanation for how acupuncture works is that channels of energy or qi [chi] run in patterns through and on the surface of the body. An obstruction in the flow of these energy rivers creates imbalance, pain and disease. When the acupuncture points are stimulated these meridians, or energy channels are influenced and a healthy flow is re-established. Physiological effects sometimes observed throughout the body include increased circulation, relief of muscle spasms, relieve from pain, decreased inflammation, and immune system stimulation.

Q: Is acupuncture compatible with western medical treatments?

A: Yes, acupuncture is a complete and well rounded healing system that can be used in conjunction with any other health care system. In China, it is very common to have an acupuncture and herbal treatment wing and a western medical wing in a hospital. For example, a patient undergoing heart surgery might be given acupuncture to boost the immune system before surgery, acupuncture anesthesia during surgery, and an IV drip of Chinese Herbs in recovery.

Q: Can several things be treated at the same time?

A: Yes. Acupuncture and TCM are holistic, which means that is we treat the whole person not just the disease. Often times, we find that multiple problems are related. If, for example, a patient comes in with headaches and painful periods, according to Chinese Medicine, that person symptoms are linked and can be addressed at the same time. The only time that we cannot treat multiple issues is when we are doing the Facial Rejuvenation.

Q: Are there any side effect?

A: No. Besides the slight risk of bruising, there are no side effects to acupuncture. The worst thing that can happen with a treatment is nothing. That is to say that the treatment would have no effect.

Q: What if I don’t like needles?

A lot of people have a fear of needles. This is normal. If a guest cannot get past the needle issue, there are other things that can be done. For example, we can do acupressure, ear seeds, nutritional and lifestyle advice. We can also prescribe herbal remedies. Again it’s important to remember that acupuncture is just a small part of what a Traditional Chinese Medicine practitioner does.

c. Acupuncture Menus (Sample – actual prices may vary)

SPECIALTY TREATMENTS

Pain Management with Acupuncture If you want to relieve aches and pains, this acupuncture treatment is for you. This pain management therapy will reduce or eliminate chronic back, neck and joint pain.first session..... 60 minutes / $150 ...............each additional session..... 45 minutes / $125

Weight-Loss Acupuncture Having trouble shedding those extra pounds? This acupuncture treatment will help you lose weight safely and effectively.first session..... 60 minutes / $150.............. each additional session..... 45 minutes / $125

Facial Rejuvenation Get a younger, more vibrant look without undergoing an invasive procedure. This natural approach to anti-aging uses acupuncture needles to reduce lines and wrinkles.first session..... 90 minutes / $175.............. each additional session..... 75 minutes / $150

“Just to Try” Acupuncture Curious about acupuncture and how it can benefit you? Try this special introductory treatment.first session..... 60 minutes / $150.............. each additional session..... 45 minutes / $125

Stress-free Acupuncture Melt away stress and worries with this deeply relaxing form of acupuncture. By focusing on specific acupoints, the healing touch of acupuncture will refresh mind, body and soul.first session..... 60 minutes / $150.............. each additional session..... 45 minutes / $125

Detox Acupuncture Restore harmony and balance in your channels and meridians by eliminating toxins. This detox treatment will cleanse the body, boost metabolism and build vital energy.first session..... 60 minutes / $150.............. each additional session..... 45 minutes / $125

Stop Smoking Kick the habit. This safe and natural treatment can be as effective as the patch or other methods used to stop smoking.first session..... 60 minutes / $150.............. each additional session..... 45 minutes / $125

Sea Sickness This treatment is designed to relieve motion sickness commonly associated with sea travel.first session..... 60 minutes / $150 .............each additional session..... 45 minutes / $125

S P E C I A L T Y P A C K A G E S

Pain-Less Acupuncture with Deep Tissue Muscle Massage Alleviate chronic pain and soothe your muscles with a specialized acupuncture treatment and a relaxing Deep Tissue Muscle Massage.110 minutes……………………………………………............................................... $205

Facial Rejuvenation Acupuncture with La Thérapie HydraLift Facial These complementary, youth-enhancing treatments provide fast and dramatic results. The combination of our Facial Rejuvenation Acupuncture and luxurious La Thérapie HydraLift Facial will leave your skin youthfully radiant.140 minutes .................................................................................................................. $265

Inch Loss Acupuncture with Ionithermie Cellulite Reduction Detoxifying the body can improve health and promote weight loss. Our detox therapies will cleanse the body, reduce the appearance of cellulite and offer substantial inch loss.130 minutes .................................................................................................................. $245

d. Treatments

i. Sea Sickness Treatments.

Sea sickness is actually very easy to treat. Therefore, we are able to provide the following.

Guaranteed cure for sea sickness for either $100 or $125.

Buying this treatment would allow the guest to get a guaranteed cure for sea sickness. If the treatment doesn’t work, i.e. the symptoms come back; the patient can come back as many times as needed for another treatment. The wonderful thing about this is that the treatments consist of a couple needles in the ear and maybe the top of the head and hands and does not require a treatment room. Treatments can be done in a chair. A guest may have to wait a few minutes for the acupuncturist to be available, but it would be done on a drop in as needed basis.

Having guests sit in chairs in the reception area with needles in their head and ears is also the best advertising for acupuncture. Guests feel almost instantly better. The treatment takes up to twenty minutes. On average, we see an 80 to 85% success rate.

Advantages of using acupuncture for sea sickness instead of other treatments are...- Safe and side effect free- The patch causes dehydration and guests are instructed not to consume

alcohol while on the patch. Acupuncture treatments for seasickness do not have this problem. Guests can eat and drink to their hearts content.

- Acupuncture is a drugless therapy. Therefore there are no contraindications based on any meds they guests may currently be taking.

- The effects of acupuncture for seasickness are immediate and long lasting.

ii. Facial Rejuvenation

Facial Rejuvenation is a new twist on cosmetic procedures. This non surgical treatment can reduce or eliminate fine lines and wrinkles in as many as three treatments. Treatments are usually done in a series of three to five, possibly more depending on a patient’s desires and goals.

The benefits of Facial Rejuvenation Acupuncture are:

1. Reduce or eliminate fine lines and wrinkles. 2. Improves muscle tone and dermal contraction3. Moisturizes the skin by increasing flow of blood and lymph. 4. Helps firm and reduce bags around the eyes and neck.5. Improves facial color by increasing peripheral circulation.6. Improves hormonal balance. 7. Tightens the pores and brightens the eyes.

8. Reduces stress evident in the face.9. Promotes overall health and well being.10. Slows the aging process from within.11. Helps to lift drooping eyelids and reduce jewels12. Reduces or eliminates double chins.

It is important to remember the Acupuncture (TCM) is holistic. While Facial Rejuvenation Acupuncture targets the face, it is a full body treatment. Points are selected based on a person’s constitutional diagnosis.

Contraindications: This treatment should not be done in the following cases. Problems with bleedingProblems with bruisingPacemakersFormer cosmetic surgerySome pituitary disordersHigh blood pressureMigrainesDiabetes PregnancyColds and Flu’sAcute herpes outbreaksAcute allergic reactions

It is very important that the Acupuncturists properly screen the guests for this treatment. Risk of bruising is very high for Facial Rejuvenation Acupuncture and this should be made known to the guest prior to treatment. Also, it is important for the guest and the acupuncturist to communicate and set forth treatment goals.

iii. Weight Loss & Stop Smoking Treatments

These two treatments, while separate, are treated very similarly. Needles are placed in the persons ear (usually 5) along with a few in the body. The first treatment is a full intake full body treatment. Subsequent treatments are 30 minutes in length and can be done sitting in a chair thereby not taking up the treatment room.

The treatment description and goals for each service are as follows.

Weight LossAcupuncture can help 1. Increase metabolism2. Decrease food cravings3. Improve digestion4. Increase will power5. Give you a sense of fullness (satiety)

Guests who experience abdominal pain and bloating, food cravings, insatiable appetite or low metabolism can all be helped by acupuncture and nutrition advice. Treatments are done as sessions and a session of weight loss could be anywhere from 3 to 5 treatments. Guests who have the treatment report feeling fuller with less food and little or no desire for sweets.

Weight loss acupuncture in conjunction with Polar Fitness, BCA or personal training is highly recommended.

Stop SmokingThis treatment, depending on the practitioner, takes anywhere between 3 to 5 treatments. Treatments are typically done one every day for the first three days, then, one day off and another treatment.

The focus of the stop smoking treatment is to reduce cravings to nicotine. The guests will be given practical and useful information that will help them with their day to day routine. It’s important to remember that acupuncture is not a magic bullet. It requires the guests to meet the practitioner half way.

It is said that when a person quits smoking (without help) they experience between 90 to 100 individual cravings a day. With acupuncture, you can reduce those craving to 10 or 12. So while you still experience cravings, they will be much less frequent and much less intense. It is those 10 to 12 cravings that the individual must find a way to get through. The acupuncturist can give some advice and suggestions for managing the remaining cravings.

Stop smoking treatments in conjunction with a detox wrap or massage is highly recommended.

e. Treatment Protocols

i. Facial Rejuvenation Acupuncture – remove years off your face and tighten skin without surgery

Therapist Checklist:

2 sheets (one covering couch and one for the guest) 1 large sarong to lie on Dry cotton pads Kleenex 70% isopropyl alcoholCheck room temperature to make sure it is comfortable for the guest A bell (for client to ring in case of emergency) Sharps container and biohazard waste container

Product Supplies:

Lavender Essential Oil Elemis facial cleanser and toner Facial Blend Hot towels Acupuncture needles Latex gloves

Room Preparation:

Set up your couch with sheet drape and sarong. Prepare one small towel the head of the bed. Have an extra sheet in to hand for client comfort.

Treatment Introduction: Acupuncture is the oldest medical system known to man. It treats pain both chronic and acute, PMS, helps to lose weight, stop smoking, aids in restoring hormonal balance and relief tension from stress. The treatments are virtually painless and use sterile, stainless steel, disposable needles.

Treatment Benefits: Diminishes fine lines and wrinkles

Relieves saggy and lusterless skinRestores vital balance in the bodyDetoxifies and heals the body

Treatment Time: 90minutes

Frequency: Determined after consultation with acupuncturist

Contra-Indications:IntoxicationBleeding disordersPeople with pacemakers (they can receive acupuncture but without electrical stimulationSevere sunburnPregnancy (can still be treated but with caution)

Acupuncture- Procedure

Perform Acupuncture Lifestyle Consultation

Prepare Client – Face UpAsk the client to lie face up on the bed with the palms resting on the couch.

The Chinese opening Touch – Herbal eye pillowSee Chinese opening Touch.

Third eye enlightenment - Lavender essential oilApply lavender essential oil to palms of the hands. After warming the hands together gently press the patient’s temples and third eye. Hold each awareness touch for 10 seconds X3

Circle massage clients temple Gently apply finger pressure circling the temples moving toward third eye. Press third eye on completion for a few seconds. X3

MeditationOne hand is placed on the patient’s crown, one on the chest. ‘A wave of energy’ downward moving. Complete with pressure at crown and then at the third eye.

Cleanse and Tone the client’s faceThe client will receive a mini facial prior to the insertion of the needles. This is done to remove any make-up or bacteria that could cause infection

Insertion of needles The point prescription focuses on the client’s areas of concern. Typically, all of the points will be on the face. Apply electrical stimulation - if performing pain management protocol or facial rejuvenation The electrical stimulation helps to contract the facial muscles thus pulling skin tighter and achieving a youthful appearance.

Complete homecare/herbal prescription

Removal of needles –wearing latex glovesAs the needles are removed, immediately place each needle into the sharps container. A cotton pad should be used to apply pressure to area of insertion for a few seconds.

Remove gloves and place any soiled material into the biohazard waste container

*Double check the patient to make sure each needle has been removed and that there is no bleeding

Facial Tui Na will be performed after all of the needles have safely been removed and no sign of bleeding is present. The acupuncturist will place a small amount of Elemis Facial Blend into their hands. Beginning at the third eye the acupuncturist will knead the forehead and temples. Continuing around the eye the acupuncturist will gently pull apart the skin around the eyes, nose and mouth. This process is repeated 3x. To end, the acupuncturist will stroke across the forehead, down the cheeks and pull up along the jaw line.

Assist patient to a seated position

Recommend lifestyle modifications and Retail

Quick Reference Treatment GridAcupunctureProcedure TimingPerform Elemis Lifestyle Consultation 15 minutesPrepare Client – Face Up with Mini facial 25 minutesChinese Opening Touch – Herbal eye compress 3 minutesAbdominal Breathing 2 minuteApplication of needles 15 minutesPrescription of homecare products 20 minutesRemoval of needles and prescription analysis 10 minutesTotal Treatment Time 90 minutes

ii. Pain Management Acupuncture – reduce acute and chronic pain. Reduce pain levels and provide more motility in conditions such as arthritis, tennis or golfer’s elbow, headaches both tension and migraine, strains and sprains. The variety of conditions is numerous.

Therapist Checklist:

2 sheets (one covering couch and one for the guest) 1 large sarong to lie on Dry cotton pads Kleenex 70% isopropyl alcoholCheck room temperature to make sure it is comfortable for the guest A bell (for client to ring in case of emergency) Sharps container and biohazard waste container

Product Supplies:

Lavender Essential Oil Acupuncture needles Latex gloves

Room Preparation:

Set up your couch with sheet drape and sarong. Prepare one small towel the head of the bed. Have an extra sheet in to hand for client comfort.

Treatment Introduction: Acupuncture is the oldest medical system known to man. It treats pain both chronic and acute, PMS, helps to lose weight, stop smoking, aids in restoring hormonal balance and relief tension from stress. The treatments are virtually painless and use sterile, stainless steel, disposable needles.

Treatment Benefits: Deeply relaxing

Relieves painRestores vital balance in the bodyDetoxifies and heals the body

Treatment Time: 55 minutes

Frequency: Determined after consultation with acupuncturist

Contra-Indications:IntoxicationBleeding disordersPeople with pacemakers (they can receive acupuncture but without electrical stimulationSevere sunburnPregnancy (can still be treated but with caution)

Acupuncture- Procedure

Perform Acupuncture Lifestyle Consultation

Prepare Client – Face UpAsk the client to lie face up on the bed with the palms resting on the couch. If the client’s area of pain in on the back, after the Chinese Opening the client will be assisted in laying face down.

The Chinese opening Touch – Herbal eye pillowSee Chinese opening Touch.

Third eye enlightenment - Lavender essential oilApply lavender essential oil to palms of the hands. After warming the hands together gently press the patient’s temples and third eye. Hold each awareness touch for 10 seconds X3

Circle massage clients temple Gently apply finger pressure circling the temples moving toward third eye. Press third eye on completion for a few seconds. X3

MeditationOne hand is placed on the patient’s crown, one on the chest. ‘A wave of energy’ downward moving. Complete with pressure at crown and then at the third eye.

Swab each area to be treated – alcohol and cotton

Insertion of needlesThe areas for the application of the needles will be dependent on the client’s condition. An example will be back pain, the needles will be inserted in the back and in the legs to provide a balanced treatment. Another could be shoulder pain, where the needles would be placed in the area of pain but in other locations to balance the body in totality.

Apply electrical stimulation - if performing pain management protocol or facial rejuvenation Electrical stimulation helps to reduce pain levels by directly stimulating the muscles that are affected.

Complete homecare/herbal prescription

Removal of needles –wearing latex glovesAs the needles are removed, immediately place each needle into the sharps container. A cotton pad should be used to apply pressure to area of insertion for a few seconds.

Remove gloves and place any soiled material into the biohazard waste container

*Double check the patient to make sure each needle has been removed and that there is no bleeding

Assist patient to a seated position

Recommend lifestyle modifications and Retail

Quick Reference Treatment GridAcupunctureProcedure TimingPerform Elemis Lifestyle Consultation 12 minutesPrepare Client – Face Up 5 minuteChinese Opening Touch – Herbal eye compress 3 minutesAbdominal Breathing 5 minuteApplication of needles 8 minutesPrescription of homecare products 15 minutesRemoval of needles and prescription analysis 7 minutesTotal Treatment Time 45 minutes

IV. Acupuncturists

a. Acupuncturist’s Educational Standards

For Steiner Management’s Acupuncture: The Point of Well-Being Program, the criteria used for recruiting our acupuncturists are as follows:

United States Educated Applicant:1) Applicant must have graduated from an NCCAOM and ACAOM accredited and

recognized program. The ACAOM is the United States governing body for accrediting acupuncture programs in the U. S. and Canada. See www.acaom.org/handbook.htm , section 8 for the complete list of criteria of eligibility for a program.

2) The program must be 4 years and at least 1900 classroom hours and 500 clinical hours.

3) The applicant must have passed the Clean Needle Technique Course.4) The applicant must be CPR/First Aid certified.5) The applicant must have taken HIV/AIDS coursework.6) The applicant must be NCCAOM certified or California State licensed.

Appendix: California State is the only state in the U.S. that has a separate exam for acupuncture. The requirements in order to graduate from a college in the state of California far exceed the minimal number of hours required by the NCCAOM. The minimal number of hours to graduate in California is 4300 classroom and clinical hours. Acupuncturists coming from the state of California qualify to sit for the NCCAOM board exam. For purposes of employment all Steiner Management requires is proof of completion from an accredited college and documentation of licensure from the state.

Each individual that passes the NCCAOM exam must then be licensed by the state in which he/her decides to practice. The only exception is California. Other states simply require registration with the state’s Board of Health and the proper occupational license. Each state has a different renewal period; in general the renewal period is 2-4 years. The NCCAOM renewal period is every 4 years. Individuals are required to have 20 hours of Continuing Educational Units (CEU’s) each year.

Applicants Educated Outside of the United States:Currently we are only accepting applicants from Canada, England, Australia, South Africa and New Zealand. These country’s programs that are recognized by their Department of Education, are equivocal to that of the United States. Per Erica Anderson, National Certification Director of Eligibility, individuals that are educated outside of the United States must 1) Attend a college or university that has a program that is recognized by the applicant’s Ministry of Education.

2) The program must be equivocal to the hours of classroom and clinic as proposed by the NCCAOM, 1900 for classroom and 500 for clinic. 3) The applicant must be proficient in English both reading and writing. 4) The program must be 4 to 5 years in length. 5) The applicant must provide proof of graduationThis is the basic criteria for any foreign applicant who wants to sit for the NCCAOM board exam. This can be seen at www.nccaom.org/educatedoutus.htm The list provided on the website is incomplete, this is why we must review each applicant individually. We are using those same criteria for hiring our applicants. We take each individual that applies and research their credentials. We make sure the program they’ve completed fits the profile allotted by the NCCAOM. We check to see if the college or university is recognized by the country’s Ministry of Education. And finally, we check each individual’s references. As for all of Steiner’s employees, we complete a thorough background check to insure the individuals we employ are reputable.

The AACMA is in fact the largest registration association in Australia. Its members are required to graduate from an AACMA, accredited program. These programs must be four to five years in length. For a full list of qualifications visit the website at www.acupuncture.org.au/study_tcm/cfm. The website also gives a list of schools in which the programs are acceptable. Each country has different renewal periods for their acupuncture licensure. As Steiner is based in Florida, we use the Florida state renewal criteria as a minimum, which is every two years. All countries listed have a renewal rate that is equivocal to this period. As stated previously, we do check each applicant’s credentials, making sure each is update and in good standing with their country’s guidelines.

Know Your Acupuncturist

Practitioners whose educational focus is in Acupuncture & Oriental Medicine receive approximately 80% of their training exclusively in this field, and undergo an extensive clinical internship averaging 3 years. Other healthcare practitioners may use acupuncture, which is one of the many therapies of Oriental Medicine, as an adjunct to their primary practice. While all of these practitioners also have training in western medical sciences, this chart is designed to illustrate the varying levels of acupuncture training generally undertaken by healthcare professionals.

Amount of Training

In Acupuncture Practitioner

1363 hours to 2000 hours in Acupuncture (or 2000-3000 hours in Oriental Medicine)* Licensed Acupuncturist Traditional Chinese Medicine Comprehensively-trained Acupuncturist Oriental Medicine Practitioner Oriental Medical Acupuncture

Typically a Licensed Acupuncturist (L.Ac.) or Registered Acupuncturist whose primary training is in Acupuncture and/or Oriental Medicine, and has: (a) obtained a 3 to 4-year master’s level degree or diploma from a school approved by ACAOM (Accreditation Commission for Acupuncture & Oriental Medicine), and (b) is awarded the Dipl.Ac. (Diplomate in Acupuncture) designation upon successful examination by the NCCAOM (National Commission for the Certification of Acupuncture & Oriental Medicine) which is the national standard used for licensing in most states. ** -Used for a broad range of health issues, including chronic disease, pain, internal medicine, rehabilitation, and prevention based on Oriental medical theory.

300 hours or less Medical Acupuncture Meridian Balancing/Therapy Chiropractic Acupuncture Naturopathic Acupuncture

Typically a medical doctor, osteopath, naturopath, or chiropractor who uses acupuncture as an adjunctive therapy; the World Health Organization (WHO) recommends that medical doctors have 200 hours of training to know when to refer to a more fully-trained Acupuncturist or Oriental Medicine practitioner.*** -Most commonly used for pain and basic ailments.

Around 100 hours or less Detox Tech Chiropractic Acupuncture Medical Acupuncture

Typically a detoxification technician or chiropractor (detox techs should be under supervision of a Licensed Acupuncturist, see above, and are limited to 5 points on the ear) -Most commonly used for pain management or addiction & detoxification through auricular acupuncture.

For a list of approved schools and colleges, contact the U.S. Department of Education or:

www.ccaom.org www.nccaom.org www.acaom.org *Many Acupuncture & Oriental Medical schools exceed 2000 hours. **Acupuncture/Oriental Medical practitioners are able to obtain a D.A.O.M. doctoral degree from an ACAOM-approved clinical doctoral program. Some states also designate the licensing title (non-degree) as D.O.M. or D.Ac, or Acupuncture Physician. Licensed Acupuncturists may have also obtained an O.M.D., Ph.D., or D.Ac. for

non-extensive post-graduate training (from unaccredited programs). Thus, it is important to ask where such a title was received. ***Some medical doctors and chiropractors are trained and licensed in both western and Oriental medical acupuncture. Ask your physician about his or her credentials. Acupuncture should only be administered by a practitioner who has specific training in this field, due to risk of improper needling, inadequate understanding of Oriental medical diagnostic procedures, transmission of disease, imbalancing of energy, or ethical violations.

V. Managing the Acupuncture Program

a. Acupuncturist Dress Code

The acupuncturist must comply with the same rules of behavior and dress that every other member of the spa abides by. Acupuncturists are expected to appear in conservative and professional attire at all times, both on the ship and in the ports of call.

Note: Please remember that we are ambassadors of our medicine as well as guests on board the ship. The utmost attention should be paid to your appearance and behavior. We are well-educated professionals and are expected to behave as such.Appearance Standards

1. Clinic Dress Code - Business attire. No open toed shoes. Lab coats are to be worn at all times with name badges. Women must have hair up and/or pulled back. Women also should wear black slacks and a plane blouse under the lab coat. Men should be clean shaven, wear slacks with a collard shirt. Clothes should be clean and neatly pressed. Men must wear dress shoes. No sneakers, sandals, old shoes or white socks are allowed. 2. Ship Dress Code - Business attire when in public areas and when walking around the ship. Denim is never allowed in any form no matter how dressy. No shorts. No bare feet. 3. Formal Nights - On formal nights, formal attire is mandatory in all public areas of the ship. This means tuxedo or jacket and tie for men, and formal gown or cocktail dress for women.4. Misc. Dress Code - Casual attire is allowed when working out in the gym, bathing in the spa or off the ship. At no time should shorts ever be worn on the ship in guest areas.5. Tattoos and Piercings - Tattoos must be covered and piercings that could offend guests must be taken out (tongue rings).

Grooming Standards1. Showering - Daily showers with soap (yes soap) prior to going to work. Make sure that your body and clothing are odor free at all times.2. Oral Hygiene – Brush or floss at least twice daily, use mouthwash to make sure your breath is clean and fresh.3. Hair - Must be clean and well groomed at all times. It is not appropriate to brush or arrange hair in the presence of guests.4. Body and Facial Hair - For women, underarms and legs should be clean- when you are in the clinic. For men, sideburns should not extend below the bottom of the earlobe. A mustache and beard grown before you sign-on should be maintained and neatly trimmed.

5. Hands and Fingernails - Hands and nails should be clean and neatly manicured to an even length. For women, do wear clear or colored nail polish, avoiding extreme tones. No designs on nails are allowed.6. Jewelry - Be moderate, a maximum one ring per hand worn on any finger may be worn. 7. Fragrances - Lightly scented perfumes, colognes, or after-shave lotions may be worn. Please avoid wearing extreme scents in the presence of guests.8. Cosmetics – These should be moderate as well, no extreme colors or shades.

Remember, the appearance of the acupuncturist is part of the medicine being taken seriously. They must appeal to main stream America. Maintaining a well groomed persona adds to your credibility and therefore your bottom line.

b. Safety Rules and Regulations for Acupuncture Onboard

1. Needles used for acupuncture are sourced from medical supply companies and are received sterilized and individually wrapped per the FDA approved method of retail selling. (In 1996, the FDA approved acupuncture needles as medical devices that were to be sterile, individually wrapped and disposable.)

2. The acupuncturist will inspect each wrapped needle. If any package or needle is found to be damaged, the needle will be properly disposed in the sharps container. All needles will be stored in a locked cabinet with the key in a secure area.

3. A clean field is established in each treatment room and is kept sterile at all times. The clean field is changed several times a day and when soiled. (A clean field an area that has been prepared to contain equipment necessary for acupuncture, in such a way as to protect the sterility of the needles. This not only includes the clean surface the equipment is placed but also the patient’s skin and surrounding areas.) A room that is equipped with a fully functional sink with clean running water is used for the acupuncturist to wash his/her hand before and after each treatment. The room designated as a treatment room must be kept free of dirt and dust. A daily cleaning log should be in clear view inside of the room and signed and dated by the therapist daily. All material used on the beds or to drape the client must remain sterile and clean. These items should be disposable, such as paper for the bed. When inapplicable, the clean linens and soiled linens must be kept separate and stored safely until usage or disposal. Products used to clean the room must be classified as disinfectants and clearly marked as such.

4. The acupuncturist should wear clean, washable or disposable protective clothing while in treatment rooms. The acupuncturist must take great care to maintain the cleanliness of his/her hands and keeping their nails short. Loose or large clothing and jewelry should be avoided. Hair should be worn as not to touch or contaminate clean fields. The acupuncturist washes his/her hands directly after entering the treatment room. Each time the acupuncturist touches any non-sterile areas, he/she must wash their hands as soon as possible. All cuts, wounds, abrasions, chapped hands, hang nails, torn cuticles, etc. must be covered with rubber gloves or finger cots. Any acupuncturist who is suffering from an infectious disease should seek immediate medical condition. Any accidental needle sticks by a contaminated needle should seek the immediate attention of a

physician. The physician should follow the exposure control plan designed by OSHA.

5. After a treatment plan has been established and points selected for the patient, each point will be cleaned with 70% solution alcohol located in a reusable dispensary. When the dispensary is empty, the acupuncturist shall thoroughly wash the dispensary and allow it to air dry. Once dry the dispensary can be refilled with the solution. The acupuncturist unwraps each just needle just prior to use and inserts each into the body. Leftover or unused exposed needles will be deposited into a sharps container that is located in each room designated to be used for acupuncture. Sharps containers shall be clearly marked as such and keep away from the clean field as it will contain contaminated needles.

6. When the acupuncturist is ready to remove the needles, he/she don latex gloves. After each removal of needles, the acupuncturist will use a cotton ball to apply pressure to each point. Each needle will be placed into a sharps container located in each treatment room away from the clean field. The sharps container should be in reach as not to carry contaminated needles for a distance. This lessens the likelihood of any cross contamination. The gloves and cotton if unsoiled can be deposited into the trash. If the gloves or cotton is soiled then it must be deposited into the biohazard container. Biohazard containers must be must be clearly marked and kept away from the clean field.

7. When the sharps container is full, the acupuncturist will deliver the container to the infirmary where the container is properly disposed. The same is for the biohazard container; it will be delivered to the infirmary when full and disposed of properly.

c. Acupuncture Flash Reports

It is imperative to the monitoring and improvement of the acupuncture program that the flash report is sent in on a daily basis. From this report we are able to analyze trends, strengths and weaknesses, and then assist daily if need be on possibilities on how to increase, improve and maximize the revenue and make the program extremely SUCCESSFUL. Your comments and observations are also important, as we can not be on your ship at all times, but can assist from reading the valuable input.

Not only is the report important for us, but it is an extremely useful tool for your onboard operations, as you can monitor the progress of your cruise on a daily basis and the rest of the cruise in advance, and make the necessary adjustments to the course of the cruise, before it is too late, and thereby increase the total service and thus the total revenue generated and the success of the cruise.

Please follow the instructions below when completing the flash report. Some of the cells in the report require entries on a daily basis and others require input on a weekly basis.

Vessel name, acupuncturist, manager name, date out, date in, number of days and cruise target are required to be entered at the start of the cruise. The cruise total and percentage need to be entered at the end of the cruise once the voyage has been completed.

Day position: entered on the first day with a date eg: 12 October 2005.

Service in: is the number of appointments you had physically for the day, and not how many was predicted prior to cancellations. This needs to be entered at the end of each day with the other information required on the report.

Appointments for the rest of the cruise: this needs to be updated at the end of every day, so that we can see where the cruise is headed at any one time and from here send assistance or ideas to increase the number of bookings. For example, on embarkation day, enter from the day sheets the number of appointments for every day of the cruise booked up until that time.

Service $: this is the dollar value to be filled in for every day for the services performed.

Retail $: this is the dollar value to be filled in for every day for the retail that has gone out.

Rebook: this also needs to be filled in on a daily basis so that we can monitor treatment totals.

Cancellations: need to be filled in at the end of each day so that we see if there is a trend to best times or port related preferences. We can also see which ports affect the acupuncture during the course of the cruise and when majority of cancellations take place, and look to implementing tools for the prevention of cancellations.

Cross promotion out: please use the key guide at the bottom of the flash report when entering this field into the report. This is vital for monitoring the links and the revenue relationship of both the team and the spa.

Cross promotion in: as per cross promotion out.

Seminars: this field needs to be entered at the start of the cruise so that we can monitor the promotion of the acupuncture, and the revenue related changes introduced from the seminars as the cruise progresses.

The total and retail% will be calculated automatically by the report, so there is no need to enter anything into these 2 fields.

Seminar name: i.e. Introduction to Acupuncture etcNumber of attend: How many guests came to that particular seminar.Number of bookings: To monitor the success rate of the seminar, and to assist in improving the seminar in the event that the productivity is low.Average age: to asses the demographic, and possibly enhance the content to increase the number of booking in relation.% Booked: This number will be automatically entered as long as you put in the number of guests attended and number booked. It’s very important that we maintain a percentage above 35%. This will be monitored very closely.

Comments, challenges and plan of action need to be entered briefly on a daily basis so that we can see where the cruise is headed, and offer assistance where needed.

We thank you in advance for your correct completion of this report on a daily basis, and in turn this will assist us in assisting you more effectively.

.

d. Managing Accidents

Accidents do happen. Accidents can range from a bruising, forgetting to remove a needle or a punctured organ (extremely rare). Accidents can not always be prevented; however they can be minimized by being careful and methodical. The following is a short list of some of the possible accidents associated with acupuncture.

1. Bruising. Bruising is common and the patients should be made aware of this. A patient is more likely to bruise if they are getting facial acupuncture, are on blood thinners or have a bleeding disorder. Bruises can be avoided by applying pressure to the area and applying a topical ointment.

2. Fainting – Fainting can result from a patient being overly tired, chronically ill or needle phobic. When this happens, remember to stay calm, make sure that the acupuncturist takes out all the needles, have the person lie down and elevate their legs. Give them some water when they regain consciousness. If the person stops breathing, dial the emergency number to contact the bridge. It’s important to note that a guest fainting is very rare. Acupuncturists are trained to deal with this situation.

3. Forgotten needle. This will happen in your spa at one time or another. Acupuncturists use a lot of needles and often times can get very busy running multiple rooms. Needles typically get lost in a patient’s hair or where clothing obscures the needle. Your acupuncturist will take the utmost care in making sure that this does not happen, however accident’s happen. If a guest comes to you complaining of a needle that has been left in them, apologize profusely, and ask for the needle so that it can be disposed of properly. Assure them that this does not happen very often and grab the acupuncturist if available. The acupuncturist will continue to apologize and will reassure the guest that no harm has been done. All acupuncturists are asked to do needles counts. This means that each practitioner should be writing down the number of needles inserted as well as the number removed on each visit.

4. Needle stick. Any practitioner accidentally stuck by a needle should be seen immediately by a physician. If this happens, immediately ascertain whether or not the patient has any blood borne diseases (hepatitis, aids etc.) The practitioner should follow the procedures set by the ships doctor concerning protocol regarding sticks by contaminated needles.

e. Biohazard Containers

Biohazard Containers. There will be one container for each room. When a container gets half-full contact the environmental officer and they will send a member of housekeeping to pick it up. Do not let the containers get too full. Use the enclosed “Biohazard Container Disposal Signature Sheet” to record the disposal of the container. A record must be kept of when the containers were picked up the and by whom. This is done in accordance with United States law.

f. Steiner Leisure Acupuncture Sanitation Guidelines

Objective:

The objective is to standardize the proper sanitization procedures for the acupuncture services.

Overview:

The policy and procedures are provided to ensure the most hygienic operation and facilities for the guests.

1.0 Policies: 1.1 All Acupuncturists and support staff must follow the procedures and

guidelines as described below.

1.2 The Spa Manager is responsible for the adherence of the acupuncturist and staff to follow all procedures.

1.3 The Spa Manager is responsible for ensuring that correct protocol is followed and for the inspection of equipment used on a daily basis as well as the evening prior to arrival into a home port to ensure that procedures are being followed.

1.4 Any staff member not following correct protocol will be subject to corrective disciplinary action and termination.

2.0 Preparation:

2.1 The Spa Manager and Acupuncturist together will consult with the Hotel Director, Chief Environmental Officer, and Ship’s Doctor to ensure compliance with all ship standards and procedures related to cleaning and sanitization; including sharps container disposal.

3.0 Training:

3.1 Review all policies and procedures with all new staff within 48 hours of sign-on and prior to their performing any acupuncture treatments;

3.2 Review this policy & procedure on a monthly basis with acupuncturists and support staff.

4.0 Procedures:

4.1 Acupuncture Needles4.1.1 Needles used for acupuncture are sourced from medical supply

companies and are received sterilized and individually wrapped per the FDA approved method of retail selling. The acupuncturist will inspect each wrapped needle.

4.1.2 All used and damaged needles will be disposed of in a sharps container.

4.1.3 If any package or needle is found to be damaged, the needle will be properly disposed in a sharps container.

4.1.4 All packaged needles will be stored in a locked cabinet with the key in a secure area.

4.2 Clean Field – Work Area/Treatment Room.4.2.1 Definition. A clean field is an area that has been prepared to

contain equipment necessary for acupuncture, in such a way as to protect the sterility of the needles. This not only includes the clean surface the equipment is placed on but also the bed, patient’s skin and surrounding areas.

4.2.2 A clean field is established in each treatment room and is kept sterile at all times. The clean field is changed after each patient.

4.2.3 Definition of Treatment Room4.2.4 A treatment room is equipped with a fully functional sink with

clean running water is used by acupuncturist to wash his/her hand before and after each treatment.

4.2.5 The treatment room must be kept free of dirt and dust. 4.2.6 Log Book. A daily cleaning log should be in clear view inside of

the room and signed and dated by the acupuncturist daily. The Spa Manager is to inspect the log book and room daily to ensure compliance.

4.2.7 All material used on the beds or to drape the client must remain sterile and clean. These items should be disposable, such as paper for the bed.

4.2.8 At all times, the clean linens and soiled linens must be kept separate and stored safely until usage or disposal.

4.2.9 Products used to clean the room must be classified as disinfectants and clearly marked as such.

4.3 Clothing, Hygiene, and Safety.

4.3.1 The acupuncturist should wear clean, washable or disposable protective clothing while in treatment rooms.

4.3.2 The acupuncturist must take great care to maintain the cleanliness of his/her hands and keeping his/her nails short.

4.3.3 Loose or large clothing and jewelry are not to be worn. Hair should be worn as not to touch or contaminate clean fields.

4.3.4 The acupuncturist must wash his/her hands directly after entering the treatment room. Each time the acupuncturist touches any non-sterile areas, he/she must wash their hands as soon as possible.

4.3.5 All cuts, wounds, abrasions, chapped hands, hang nails, torn cuticles, etc. must be covered with rubber gloves or finger cots.

4.3.6 Any acupuncturist who is suffering from an infectious disease should inform vessel staff and seek immediate medical attention.

4.3.7 Any accidental needle sticks by a contaminated needle should be seen by immediately by a physician.

4.4 Pre and Post Needle Application.4.4.1 After a treatment plan has been established and points selected for

the patient, each point will be cleaned with 70% solution alcohol located in a reusable dispensary.

4.4.2 When the dispensary is empty, the acupuncturist shall thoroughly wash the dispensary and allow it to air dry.

4.4.3 Once dry the dispensary can be refilled with the solution. 4.4.4 The acupuncturist unwraps each needle just prior to use and inserts

each into the body. 4.4.5 Leftover or unused exposed needles will be deposited into a sharps

container that is located in each room designated to be used for acupuncture.

4.4.6 Sharps containers shall be clearly marked as such and keep away from the clean field as it will contain contaminated needles.

4.4.7 When the acupuncturist is ready to remove the needles, he/she must wear latex gloves.

4.4.8 After each removal of needles, the acupuncturist will use a cotton ball to apply pressure to each point.

4.4.9 Each needle will be placed into a sharps container located in each treatment room away from the clean field.

4.4.10 The sharps container should be in reach as not to carry contaminated needles for a distance. This lessens the likelihood of any cross contamination. The gloves and cotton if unsoiled can be deposited into the trash.

4.4.11 If the gloves or cotton are soiled then they must be deposited into the biohazard container.

4.4.12 Biohazard containers must be must be clearly marked and kept away from the clean field.

4.4.13 When the sharps container is full, the acupuncturist will deliver the container to the infirmary where the container will be properly disposed.

4.4.14 The same applies to the biohazard container; it will be delivered to the infirmary when full and disposed of properly.

VI. Promotion/Advertising

a. Acupuncture Advertising & Promotion Checklist

*Because the revenue generated by acupuncture is incremental revenue it should be promoted from outside the spa. General advertising should be done in the spa, however as much advertising and promotion as possible should be done outside the spa. We are trying to reach a new clientele and not take revenue from existing services.

EmbarkationPart of the Spa Tour - This is a good time for the acupuncturists to be signing guests up for free consultations.

Promo on the Promenade – If the acupuncturist is not part of the spa tour, then they should be down on a main deck doing demonstrations. Make sure that they get models before hand and are set up with a table and supplies. These demonstrations are great for attracting a crowd.

Promoting Free Consultations – Everyone (therapists, acupuncturists, and managers) should be promoting free 5 to 15 minute consultation with the acupuncturist. The acupuncturist is trained to turn these into treatments.

Promoting the Lecture – Signs in the spa should promote the first acupuncture lecture. Also, handing out Raffle Tickets to guests during embarkation will increase lecture attendance.

LectureRaffle Tickets for Lecture – Tickets are used to increase lecture attendance and should be handed out during embarkation and spa tours. Please see sample attached.

Sign at Front Desk – A framed sign with lecture location and time should be placed in an easily seen location. Preferably on the front desk with a frame. The acupuncturists’ bio with photo can also be attached.

Therapists Inviting Guests – All therapists should be made aware of lecture time and location in order to invite their clients’.

Cabin Drop Advert – A shell with the lecture promotion can be used as a cabin drop.

Advert in Program – If a cabin drop cannot be done, a separate (from the spa) advertisement should be in the daily program advertising the lecture.

Announcement Made by Cruise Director – Whenever possible, an announcement by the CD will greatly increase lecture turnout.

Sign at Lecture – A sign and/or greeter should be present at the lecture 10 to 15 minutes before it starts.

Inviting Guests During Embarkation – Acupuncturist and therapists should always be promoting the lecture during embarkation.

General AdvertisingReferrals from Other Therapists – This should be the biggest source of income. A referral incentive should be in place. For example an hour off for each acupuncture referral.

Specials (Port Day, Mix and Match etc.) – Please see attached examples of acceptable specials.

Daily Program Advert – As much as possible wherever possible, some sort of advertising should be in the daily program.

Bio with Photo and Frame at Reception – This should be at or near the front desk at all times.

Shell Promoting Acupuncture at Front Desk – Like all other services, acupuncture should be included with all promotions.

Video on Stateroom Television – There are two ways we can go with this. Having both is always best. The first one would be an interview with the cruise director the second would be a sample treatment that traditionally has lasted about ten minutes. Another video that we can do is to videotape the lecture and have it run in a loop on stateroom television.

Slide Show on Plasma Screen – If your spa has plasma screens, a promotion for acupuncture should have a rotation.

RelationshipsAll officers and department heads should be in for a free acupuncture treatment so that they can meet the therapist and learn about acupuncture. They will be a big source of referrals due to their relationships with guests. I encourage this as much as possible for all staff and crew members who deal directly with the guests. In addition, when possible the acupuncturists should be using Bingo, Port & Shopping Seminars and Art Auctions to promote themselves. The acupuncturist should also be sent to events to socialize whenever possible. Frequent cruiser’s parties, Captain’s parties etc.

Ongoing EducationIn conjunction with the Relationships mentioned above, the entire crew should be made aware of acupuncture and what it can do. This can be done by sending the

acupuncturist to do mini lectures for various departments during their meetings. This can also be done by setting up an informational table on the crew deck.

b. Acupuncture Advertisements/Collateral

Acupuncture Menus/Table Cards

Acupuncture Prescription Pads

Acupuncture intake form

Acupuncture Shell

Large acupuncture banner with stand.

Acupuncture PowerPoint Promo Slide

Acupuncturist’s Bio

Acupuncture Lectures on PowerPoint

ACUPUNCTUREThe Point of Well-Being

Name: _____________________________________ Stateroom #: ___________________________________________Cruise Line: _________________________________ Vessel Name: _________________________________________Date of Birth: _______________________ Height: ____________ Weight: _____________ Sex: ❑ Male ❑ FemalePrimary Reason for visit _____________________________________________________________________________When did the problem begin: ____________________ Under physician care for this problem: ❑ Yes ❑ NoWhat other treatments have you tried? _____________Have you tried acupuncture before: ❑ Yes ❑ NoAllergies? (drugs, chemicals, foods, etc.) ___________ Are you on a restricted diet or exercise program? ❑ Yes ❑ NoWhat medications or supplements are you taking? ________________________________________________________Check the products that are used: ❑ cigarettes ❑ alcohol ❑ coffee ❑ tea ❑ soft drinks ❑ drugsHow often are these product(s) used a week? ___________________________________________________________

MEDICAL HISTORY (please check all that apply)❑ Cancer ❑ Heart Disease ❑ Diabetes ❑ Thyroid Disease ❑ High/Low Blood Pressure❑ Bleeding disorders ❑ Stress ❑ Transmittable Diseases ❑ History of Family Illness ❑ Sleep disorders❑ Other __________________________________________________________________________________________

GENERAL❑ Heart palpitations ❑ Shortness of breath ❑ Night Sweats ❑ Sweating easily ❑ Edema❑ Fatigue ❑ Sudden energy drop ❑ Pain: (where/type)____________________________________________________Notes: ___________________________________________________________________________________________

HEAD/EARS/EYES/NOSE/THROAT❑ Headache/Migraines ❑ Blurry/Impaired vision ❑ Eye dryness/pain ❑ Recurrent sore throat ❑ Swollen glands❑ Nasal discharge/bleeding ❑ Ringing in ears ❑ Earache/Ear discharge ❑ Other _______________________________Notes: ___________________________________________________________________________________________

DIGESTION❑ Heartburn ❑ Discomfort after eating ❑ Abdominal pain/cramps ❑ Nausea ❑ Constipation❑ Other__________________________________________________________________________________________Notes: ___________________________________________________________________________________________

GENITO-URINARY❑ Bladder/kidney infections ❑ Painful urination ❑ Unable to hold urine ❑ Urgency with urination ❑ Kidney Stones❑ Other __________________________________________________________________________________________Notes:___________________________________________________________________________________________

GYNECOLOGICALAre you pregnant? ❑ Yes ❑ No ❑ Irregular periods ❑ Light periods ❑ Heavy periods❑ PMS ❑ Endometriosis ❑ Infertility ❑ Fibroids ❑ Breast lumps❑ Other____________________________________________________________________________________________Notes:___________________________________________________________________________________________

NEUROLOGICAL/BEHAVORIAL❑ Stroke ❑ Paralysis ❑ Poor memory ❑ Difficulty concentrating ❑ Depression❑ Anxiety ❑ Panic Attacks ❑ Irritability ❑ Poor balance ❑ Dizziness❑ Other __________________________________________________________________________________________Notes: ___________________________________________________________________________________________

LIABILITY RELEASE, ACKNOWLEDGEMENT AND WAIVER

I, (please initial) _____________ , in consideration of being permitted to participate in the Acupuncture services provided by Steiner Transocean Limited, do, for myself, my spouse, my heirs, executors,

administrators, successors and assigns hereby fully release and forever discharge Steiner Transocean Limited, and its employees, agents, affiliates, directors, officers, landlords, representatives successors, assigns, subsidiaries and parents, of and from any and all actions, causes or right of action, suits, damages, judgments, executions, claims and demands whatsoever, by reasons of any matter, cause or thing whatsoever, known or unknown, arising from, related to, resulting from, or in a any way connected with my participation in Acupuncture services, including but not limited to, those resulting from bodily injury, theft, loss of, or damage to property of mine.

I, (please initial) _____________ fully understand, acknowledge and agree that: (i) the Acupuncture services offered by Steiner Transocean Limited involve risks; (ii) I have provided Steiner Transocean Limited with all medical information regarding my current health status; iii) I am seeking the Acupuncture procedure at my own free will; (iv) I assume all risks associated therewith; iv) I fully understand that the Acupuncture services are not treatments for any medical emergencies or conditions; and v) I understand that no statement of the Acupuncture provider is intended as a medical diagnosis, nor is it to be considered as such.

I, (please initial) _____________ further, fully understand, acknowledge and agree all spa and salon services, including Acupuncture services, are provided exclusively, as a convenience to me, by Steiner Transocean Limited and I accept the service at my own risk and expense without liability or responsibility to the cruise line and/or Carrier.

I, (please initial) _____________ further, fully understand, acknowledge and agree that I am bound to the terms of the cruise line and/or Carrier’s passage ticket contract and that all of the terms and conditions provided within are applicable to me for any and all claims which I may have against Steiner Transocean Limited, including my agreement that all claims that I may have arising out of or relating to any spa or salon services, shall be brought only against Steiner Transocean Limited, c/o Steiner Managements Services, before a court located in Miami Dade, Florida, U.S.A. within 12 months of the date of occurrence.

I hereby acknowledge that I have carefully read this entire agreement and sign below to acknowledge my agreement to all of the terms above:

________________________ ________________________________________ _______________________Name (print) Signature Date

THIS AREA FOR OFFICE USE ONLYTongue: _________Pulse: ________Point Prescription: __________________________________________________________________________________Lifestyle Modification Prescription: _____________________________________________________________________Follow-up appointments: _____________________________________________________________________________Remarks: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

www.timetospa.com

c. Spa Packages/Cross Promotions (Suggestions only – prices have not been set.)

Detox Package (or Weight Loss) 25 min. Detox Acupuncture50 min. IonithermieCharge full Ionithermie price and half of Acupuncture first session price ($75).

Facial Rejuvenation Package25 min. Facial Rejuvenation Acupuncture ($75)25 min. Mini LT Facial ( ????)

For just $_______

Weight Loss ProgramElemis Cellutox Aroma Spa Ocean Wrap 25 min. Detox Acupuncture ($75)

For just $_______ (maybe a 20% discount on Aroma Spa)

Tension Relief25 min. Stress Free Acupuncture ($75)25 min. Massage (????)

For Just $_______

Relaxation Package75 min. Aroma Stone Therapy 45 min. Stress Free AcupunctureFor just $_____ (20% discount) while the ship is in port.)Regular Price at Sea – straight promo – no discount.

Acupuncture TreatmentReceive your choice of a full body acupuncture treatment for 20% while the ship is in port.Choose from:LIST ALL TREATMENTS

Pick N’ Mix25 min. Balancing Acupuncture Session ($75)25 min. Mini LT Facial (?????)25 min. Massage (?????)Choose two for just $_______ (Greg, determine price)

Couples Acupuncture“Just to Try” Acupuncture for Couples while the ship is in portFor just $250 (save $50)

Fitness Package

Body Composition AnalysisWeight Loss Acupuncture (full treatment $150)Personal Training Session

Port Days (maybe a 20% discount) Acupuncture for Sea SicknessUnlimited Acupuncture for Sea Sickness treatments during your cruise for just $150!!!

VII. Miscellaneous

a. Acupuncture Supplies

The acupuncturist’s room should be stocked with the following supplies. If you are fortunate enough to have two rooms available, most of the supplies will be shared between the multiple rooms. All supplies should be in place before the practitioner arrives. Please contact us if this is not so. Reordering should be done by filling out the appropriate form. Please allow enough time for the order to reach the ship as it will be impossible for you to get needles in most ports.

The following list of supplies should last approximately 3 and a half months. .

Wall charts-ct.ac.wall4- one set5- alcohol- alcohol swabs1- Halsteads1- Tweezers-dres52- Glass Jars-jar.glass.32- saucer.M-saucer.m

1-angle P ear P angle probes10- vaccar. C-seeds-vaccar.5010- one quart sage sharp’s container-sage.1.qt10- biowaste bags0- Set of Bells – we need to find different ones

NEEDLESDBC’sdSB.18x15-1000dSB.20x30-2000dSB.25x30-2000dSB.20x40-4000Hwato HB.35x125-200 SEIRINS Sj.14x30-0Sj.16x30-1000Sj.20x30-0Sj.25x50-0

One box of small and medium latex gloves.

b. Glossary

Chinese medicine brings with it many terms that our unfamiliar to most people. The following are simple explanations for many encountered terms.

Acupuncture (noun) - A procedure used in or adapted from Chinese medical practice in which specific body areas are pierced with fine needles for therapeutic purposes or to relieve pain or produce regional anesthesia

Traditional Chinese Medicine (noun) – A whole medical system that was documented in China by the 3rd century BC. TCM is based on a concept of vital energy or qi that is believed to flow throughout the body. It is proposed to regulate a person's spiritual, emotional, mental, and physical balance and to be influenced by the opposing forces of yin (negative energy) and yang (positive energy). Disease is proposed to result from the flow of qi being disrupted and yin and yang becoming unbalanced. Among the components of TCM are herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and remedial massage

Qi (noun) - the circulating life energy that in Chinese philosophy is thought to be inherent in all things; in traditional Chinese medicine the balance of negative and positive forms in the body is believed to be essential for good health.

Yin (noun) - The passive, female cosmic principle in Chinese dualistic philosophy

Yang (noun) - The active, male cosmic principle in Chinese dualistic philosophy

Qigong (noun) - a type of ancient Chinese system of postures, exercises, breathing techniques, and meditations to improve one's chi/qi (energy field); also called chi kung, chi gong, chi gung, daoyin

Meridian (noun) - A traditional Chinese medicine term for each of the 20 pathways throughout the body for the flow of qi, or vital energy, accessed through acupuncture points.