Dry Needling 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, impairment and disability. 

Benefits. Dry Needling has been shown to be effective for reduction of swelling, muscle tightness and stiffness and symptoms of pain. Dry Needling works to increase elasticity and mobility of connective tissue and promotes self-healing. 

Risks. Like any medical procedure, 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.

• Puncture of a Lung (Pneumothorax) – If this were to occur, it may require a chest x-ray and no further treatment. The symptoms of shortness of breath may last for several days to weeks. A more severe lung puncture, while rare, may require hospitalization

• Bruising

• Soreness

• Infection

• Nerve Injury

• Organ Puncture

• Dizziness

• Fainting

  
  

Consent.

I have read and fully understand this consent form and attest that no guarantees have been made on the success of this procedure related to my condition. I am aware that multiple treatment sessions may be required, thus this consent will cover this treatment as well as subsequent treatments by this therapist. All of my questions, related to the procedure and possible risks, were answered to my satisfaction.

My signature below represents my consent to the performance of dry needling and my consent to any measures necessary to correct complications, which may result. I am aware I can withdraw my consent at any time. I also acknowledge that needling is being performed as a modality in order to decrease pain and connective tissue adhesions and should be replace advice or assessment by a medical doctor or a

full formal physical therapy treatment plan.