Shockwave Therapy Intake Form

What is Shockwave Therapy?
Shockwave Therapy (Extracorporeal Shockwave Therapy or ESWT) is a non-invasive treatment that uses acoustic pressure waves to stimulate the body's natural healing response. It may be used to help reduce pain, improve circulation, break down scar tissue or fibrosis, improve tissue mobility, and support healing of musculoskeletal and soft tissue conditions.

While many patients experience improvement, individual results vary and no guarantees can be made regarding treatment outcomes.

I understand Shockwave Therapy may not be appropriate if I have:

• Active cancer in the treatment area

• Pregnancy (over certain treatment areas)

• Active infection

• Blood clotting disorders

• Recent fracture

• Open wounds

• Severe circulatory disorders

• Implanted electronic devices where treatment is contraindicated

 

I voluntarily consent to receive Shockwave Therapy provided by Lymphyx and authorize the provider to perform treatment as clinically indicated.

I understand the benefits, possible risks, alternatives, and limitations of treatment.

 

I understand that Shockwave Therapy may not be covered by insurance and I accept financial responsibility for services rendered unless otherwise agreed.

I voluntarily authorize Lymphyx to use photographs and/or videos taken during my treatment for marketing, educational, and promotional purposes, including but not limited to social media, the Lymphyx website, printed materials, and other digital or print media.

I understand that:

My participation is entirely voluntary and will not affect my care or treatment.
I may decline or withdraw this consent at any time by providing written notice to Lymphyx. I understand that withdrawal will not apply to materials that have already been published or distributed.
I understand that once images are shared publicly, Lymphyx cannot control how they may be viewed, shared, or reproduced by others.

 

 

To help optimize your treatment experience and support your body's natural healing response, please follow these recommendations before and after your Shockwave Therapy session.

Before Your Appointment
Drink plenty of water during the 24 hours prior to your treatment.
Eat a light meal if needed before your appointment.
Wear comfortable clothing that allows easy access to the treatment area.
Inform your practitioner of any recent injuries, surgeries, changes in your health, or new medications.
Avoid applying lotions, creams, or oils to the treatment area on the day of your appointment.
After Your Treatment
Continue to stay well hydrated for the next 24–48 hours.
Mild soreness, tenderness, redness, or temporary swelling may occur and is a normal response to treatment.
Avoid vigorous exercise involving the treated area for 24–48 hours unless otherwise instructed.
Avoid taking anti-inflammatory medications (such as ibuprofen, naproxen, or similar NSAIDs) for 48 hours after treatment unless prescribed by your physician, as they may interfere with the body's natural healing response. Acetaminophen (Tylenol®) may be used for discomfort if appropriate for you.
Resume normal daily activities as tolerated.
If you have been advised to wear a compression garment, continue wearing it as directed following your treatment. Compression can help support the treated tissues, assist with fluid management, and complement your body's natural healing response.
Treatment Expectations
Shockwave Therapy stimulates the body's natural healing processes. Improvements often occur gradually over several weeks as tissues continue to respond.
Multiple treatments are typically recommended for optimal results, depending on the condition being treated.
Individual responses vary based on tissue condition, healing capacity, and overall health.
Client Acknowledgment
I acknowledge that I have received and understand these pre- and post-treatment instructions. I understand that following these recommendations may help optimize my treatment results.