Consent to Dry Needling & Acupuncture

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Consent to Dry Needling & Acupuncture

Dry Needling and Acupuncture involves inserting tiny monofilament needle in a muscle or muscles in order to release shortened bands of muscles and decrease trigger point activity. This can help resolve pain and muscle tension, and will promote healing. This is not traditional Chinese Acupuncture, but is instead a medical treatment that relies on a medical diagnosis to be effective.

RisksThough unlikely, there are risks associated with this treatment. The most serious risk is accidental puncture of the lung (pneumothorax) when needling in the chest or upper back areas. If this were to occur, medical investigation and treatment would be required. This is a rare complication, and it should not be a major concern. Other risks include injury to a blood vessel causing a bruise, infection, and/or nerve irritation. Bruising is a common occurrence and should not be a concern. As the needles are very small and do not have a cutting edge, the likelihood of any significant tissue trauma from trigger point dry needling is unlikely.

Are you pregnant or is there any chance you may be pregnant?

Are you immunocompromised?

Are you taking blood thinners?

Do you have any disease or infection that can be transmitted through bodily fluids?

Do NOT sign this form until you meet with your physiotherapist

I hereby acknowledge that I have read this form and discussed with the physiotherapist the assessment of my condition and the treatment plan. I Understand the nature of the treatment to be provided to me. I have considered the benefits and risks of treatment, as well as the alternatives to treatment. I note that II hereby consent to dry needling & acupuncture treatment as proposed to me.

Signature of patient (or legal guardian)(Required)