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Dry Needling Consent

Please fill out the following form prior to receiving Dry Needling Treatments.

Dry needling (DN) is a skilled technique performed by a physical therapist using a single-use, single-insertion, sterile filiform needle, which is used to penetrate the skin or underlying tissue to effect change in body conditions, pain, movement,  and impairment. Like any treatment there are possible complications.

While these complications are rare in occurrence, they are real and must be considered prior to giving your consent for dry needling treatment. 

Are you taking any blood thinners? Could you be pregnant? Do you have any issues with your immune system? Do you have any known disease or infection that could be transmitted through bodily fluids? Do you have any implants?
Have you had Dry Needling or Acupuncture previously?

Thanks for submitting, we'll see you at your appointment!

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