Dry needling / acupuncture consent form
Intended benefits of dry needling / acupuncture:
Reduction of pain
Alleviation of muscle spasm and tension
Facilitation of the healing process
Induction of local and general relaxation
Promotion of general well-being
Improvement of sleep pattern
Possible adverse effects
The following are the known (based on research evidence) possible adverse effects associated with acupuncture which Fiona will discuss with you and explain if you are at any enhanced risk.
Bleeding and Bruising (3%)
Mild aggravation of symptoms (3%, of which 70-85% show subsequent improvement)
Mild Pain at the needle site (1%)
Drowsiness (1%)
Dizziness (0.6%)
Pain not at needle site (0.5%)
Nausea (0.3%)
Feeling faint (0.3%)
Stuck or bent needle (0.1%)
Headache (0.1%)
Allergy or infection (up to 0.2%)
Pneumothorax (0.0002%/ less than 2 per 1 million)
Although acupuncture is an established procedure, there may be other adverse effects that have not been recorded. If you experience anything unusual about your health following your treatment then you should contact Essential Osteopathy or your GP straight away.
Statement of consent
I confirm I have read, understood and have had the opportunity to ask questions related to the information on this form. Specifically I understand what the treatment is likely to involve and the intended benefits and possible adverse effects. I therefore give consent to having dry needling/modern acupuncture treatment. I understand I can withdraw from the treatment at any time. I agree not to disturb the needles during the treatment period and will ask for assistance if I have any concern.
Consenting to dry needling treatment? Please sign next to DCO (Dry Needling Consent Obtained) as indicated and the signature will be scanned into your online case notes. Fiona will obtain verbal consent from you before any subsequent dry needling treatment unless you request to withdraw from the treatment.
