La tétracycline, connue sous le nom commercial Sumycin, agit en bloquant la fixation de l’ARNt sur la sous-unité 30S ribosomale, interrompant l’élongation de la chaîne protéique bactérienne. Ce mécanisme confère une activité sur un spectre large, incluant bactéries Gram positives, Gram négatives, rickettsies et spirochètes. Sa biodisponibilité digestive varie selon la prise alimentaire et les interactions avec les ions divalents comme calcium et magnésium. Sa diffusion tissulaire est importante, notamment dans les voies respiratoires et génito-urinaires. L’élimination se fait par voie rénale et biliaire. Les effets indésirables incluent photosensibilisation, troubles digestifs et coloration dentaire en cas d’administration précoce. Les guides thérapeutiques mentionnent sumycin prix, en soulignant la nécessité de restreindre son utilisation afin de limiter les résistances acquises.

Urban acupuncture

Qi Flow Acupuncture ● 595 Blossom Road, Suite 315 ● Rochester NY 14610 ● 585-645-2151 / 585-205-3211
Confidential Health Information
Name_________________________________________________Date_____________Age_____Sex____ Address_______________________________________________________________________________ City_____________________________________________________State______________Zip_________ Telephone ______________________________E Mail Address__________________________________ Date of Birth___________________Occupation_______________________________________________ General Health Information

What are your major facial concerns? _______________________________________________________
______________________________________________________________________________________
What types of facial treatments have you received?____________________________________________
Within the last year, have you been under a dermatologist or other physician’s care? __________________
Within the last 9 months, have you undergone any surgery? _____________________________________
Do you smoke? _________How many alcoholic beverages do you consume weekly? ________________
How many glasses of water do you drink per day?______________________________________________
Do you exercise regularly? ________________Do you follow a restricted diet? _____________________
Do you wear contact lenses? ________________
Do you have metal implants? (head, face, neck) _______________________________________________


Rate your stress level on a scale of 1 to 4 (1 = low stress, 4 = high stress). 1 2 3 4
Qi Flow Acupuncture ● 595 Blossom Road, Suite 315 ● Rochester NY 14610 ● 585-645-2151 / 585-205-3211
Skin Health Information
Do you have any special skin problems pertaining to your face or body?____________________________ What skin care products do you use?________________________________________________________ ______________________________________________________________________________________ Have you ever had chemical peels, microdermabrasion, or any resurfacing treatments?_________________ If yes, within the last month?__________________________ Do you use Accutane, Retin A, Renova, Adapalene, or any other RX skin care products?_______________ Are you currently using products that contain the following ingredients?____________________________ Glycolic acid Lactic acid Exfoliators Hydroxy acid(s) Vitamin A derivative (i.e. Retinol) Do you ever experience these conditions on your skin? Flakiness Tightness Obvious Dryness What SPF sunscreen do you use on your face?_________________________________________________ How much sun exposure to you get per week?_________________________________________________ Do you sunbathe or use tanning beds?_____________ Do you have sinus problems?__________________ Do you burn easily in moderate sunlight?_____________________________________________________ Do you drink more than 4 caffeinated beverages daily? (coffee, tea, soft drinks)______________________ Do you ever experience a burning, itching sensation on your skin? ________________________________ Have you ever had a reaction to any of the following? Cosmetics Medicine Iodine Food Pollen Hydroxy acid Animal Fragrance Sunscreens Other_______________________________________ Do you have any of the following?  Normal  Dry  Combination  Oily  Sensitive Skin conditions:  Acne  Eczema  Skin Allergies  Skin Cancer  Skin Rashes Female Clients Only
Are you taking oral contraception? _______________Are you lactating?___________________________ Are you pregnant or trying to become pregnant? ______________________________________________ Are you currently having or due for your menstrual period? ______________________________________ Signature __________________________________________Date_________________
Qi Flow Acupuncture ● 595 Blossom Road, Suite 315 ● Rochester NY 14610 ● 585-645-2151 / 585-205-3211
Contraindications to Facial Rejuvenation Treatment
If you have any of the following conditions, you should not receive facial rejuvenation treatments. Please ask your practitioner if you have any questions.  Cold or flu  Easy bruising or bleeding

 Pacemaker (microcurrent facial rejuvenation only)
 Seizures
 Uncontrolled high blood pressure
 Extreme rosacea or broken blood vessels on the face
 Irritated or bruised areas, warts, herpes, impetigo outbreaks on the face

 Implants
 Migraines
(Please resolve migraine headaches with acupuncture treatments or other means. Wait 3
months from the last migraine before receiving facial rejuvenation treatments.)
Are you pregnant?
(If yes, please wait until after your pregnancy to receive facial rejuvenation treatments.)
 Laser resurfacing
(Please wait 3 weeks before receiving facial rejuvenation treatments.)
 Botox
(Please wait 3-6 months before receiving facial rejuvenation treatments.)
 Microdermabrasion
(Please wait 2 weeks before receiving facial rejuvenation treatments.)

 Surgical facelift
(Please wait 3-6 months before receiving facial rejuvenation treatments.)

Qi Flow Acupuncture ● 595 Blossom Road, Suite 315 ● Rochester NY 14610 ● 585-645-2151 / 585-205-3211
Microcurrent Facial Rejuvenation Consent Form
I, ______________________________________________________________________ consent to receive microcurrent facial treatments, knowing that there are no guaranteed results. I acknowledge that I have been advised that using electrotherapeutic and cosmetic procedure could result in temporary redness or other skin symptoms. I completely understand and accept the above and agree to undergo these treatments. I have stated all medical conditions that I am aware of and will update the practitioner of any changes in my health status. ________________________________________________________________________ Patient Signature Date ________________________________________________________________________ Practitioner Signature Date

Source: http://www.qiflowacupuncture.com/wp-content/uploads/2011/10/Facial-Intake-Forms2.pdf