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  • Dry Needling Consent Form

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  • Dry needling is a technique used by physical therapists to treat pain and dysfunction in muscles and connective tissue. This procedure involves inserting a thin, sterile, solid filament needle into trigger points or tight bands of muscle tissue to reduce pain, improve mobility, and restore function.

    Purpose and Procedure:

    Dry needling may be used as part of your physical therapy treatment plan to address musculoskeletal pain, movement impairments, or neuromuscular dysfunction. The technique is different from acupuncture and is based on Western medical principles.

    Potential Benefits:

    • Reduction in muscle tension and pain
    • Decreased inflammation
    • Accelerated recovery
    • Improved range of motion and function

    Possible Risks and Side Effects

    While generally safe, dry needling may cause:

    • Mild discomfort or soreness at the needling site
    • Bruising or bleeding
    • Fatigue or dizziness
    • Rarely, nausea or fainting
    • In extremely rare cases, infection or pneumothorax (lung puncture)

    If you have a fear of needles, a bleeding disorder, are pregnant, or have any other condition that may impact treatment, please inform your therapist prior to the procedure.

    Acknowledgment and Consent


    By signing below, I acknowledge that:

    I have discussed the dry needling procedure with my therapist.

    I understand the risks, benefits, and alternatives to treatment.

    I have had the opportunity to ask questions and all my questions have been answered to my satisfaction.

    I voluntarily consent to receive dry needling treatment as part of my care at Associates Physical Therapy.

    I understand I can withdraw my consent at any time.

     

     

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