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Waiver and Liability of Consent Form

Dry Needling 
Adverse effects 

  • DN can elicit transient changes in blood pressure 

  • DN can elicit fainting may occur 

  • DN can reduce blood sugar levels

  • Although we follow best evidence-based practices and risk is less then 1%, there is an adherent risk of needles to punctures to lungs, kidneys, or liver. 

    • A puncture to the lungs could cause a pneumothorax. ​

    • A puncture to the kidneys could cause pain in the thoracolumbar junction, hematuria. 

    • A puncture to the Liver or spleen may cause internal bleeding, local pain, severe tenderness and spasm of the surrounding areas.  

  • There is a risk of skin infection.

Dry Needling Information & Waiver

Please fill out the following form
in order to participate in our activity.

Are you pregnant?
Are you suffering from a medical condition, seizures, illness, or injury?
Have you been hospitalized or had Covid-19 in the last 12 months?

Thanks for submitting!

Waiver and Liability of

Informed Consent 

Do you have a doctor’s permit to participate in intense physical activities?

Thanks for submitting!

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