If yes, please make sure your GP has confirmed sports therapy treatments are safe for you to proceed and if possible, please inform us of the medications so we may assess risks.
If yes, for how long?
e.g. Physiotherapy, Chiropractor, Osteopathy etc.
What activities do you do and how frequent?
Patient Information and Consent Form for Acupuncture / Dry Needling
Please read this information carefully and ask Simon if there is anything you do not understand.
What is Acupuncture / Dry Needling?
Acupuncture / dry needling is a form of therapy in which fine needles are inserted into specific points of the body.
Is Acupuncture / Dry Needling Safe?
Acupuncture is generally very safe. Serious side effects are very rare – less than 1 per 10,000 treatments.
Does acupuncture/ dry needling have side effects?
You need to be aware that:
• Drowsiness occurs after treatment in a small number of patients, and if affected, you are advised not to drive.
• Minor bleeding or bruising occurs after acupuncture in about 3% of treatments; pain during treatment occurs in about 1% of treatments.
• Existing symptoms can get worse after treatment (less than 3% of patients). You should tell your acupuncturist about this, but it is usually a good sign.
• Fainting can occur in certain patients, particularly at the first treatment.
• If you consent to receive acupuncture treatment from Raw Power Massage practitioner, Simon Harrison, you cannot give blood until it has been 4 months from completion of your acupuncture treatment.
In addition to the particular risks that apply, you must notify Simon of the following-
• If you have ever experienced a fit, faint of funny turn
• If you have a pacemaker or any other electrical implants
• If you have a bleeding disorder
• If you are taking anti-coagulants or any other medication
• If you have damaged heart valves or have any other particular risk of infection
Single use, sterile, disposable needles are used in the practice.
Statement of Consent
I confirm I have read and understood the above information on acupuncture and I hereby give consent to having acupuncture treatment. I understand that I can refuse treatment at any time.
Thank you for submitting your pre-screening information.
This will enable us to consider the questions and modalities of treatment to consider for when we meet.
Kind regards
Simon
