Shockwave Therapy Consent Form

Shockwave Therapy Consent Form

Patient & Provider Information

Introduction / Purpose

Shockwave Therapy is a non-invasive treatment using acoustic waves to promote healing, reduce pain, improve circulation, and stimulate tissue regeneration. It is commonly used for musculoskeletal conditions, chronic pain, tendonitis, and soft tissue injuries.

Treatment Overview / How It Works

  • Acoustic waves are delivered to the targeted area via a handheld device

  • Each session typically lasts 10–20 minutes, depending on the condition and treatment plan

  • Treatment frequency varies: usually 1–2 times per week for several weeks

  • Sessions may produce mild discomfort, pressure, or tingling

Contraindications & Warnings

Do not use Shockwave Therapy if you have:

  • Blood clotting disorders or are on anticoagulant therapy

  • Pregnancy

  • Active infection at the treatment site

  • Malignancy or tumor in the treatment area

  • Acute fractures or open wounds

Caution is advised for patients with:

  • Cardiac pacemakers or implanted devices near treatment area

  • Severe neurological disorders

  • Osteoporosis or fragile bones

Possible Risks / Side Effects

  • Mild pain, tenderness, or bruising at the treatment site

  • Temporary swelling or redness

  • Numbness or tingling (rare)

  • Rare risk of injury to nearby nerves or soft tissue

Pre-Treatment Instructions

  • Avoid anti-inflammatory medications 24–48 hours before treatment (unless prescribed)

  • Wear comfortable clothing allowing access to the treatment area

  • Inform the provider of any medical conditions or recent injuries

During Treatment / Application

  • The provider will apply the shockwave device to the affected area

  • Mild discomfort or tapping sensation may occur

  • Notify staff immediately if pain is severe or unusual

Post-Treatment / Aftercare

  • Mild soreness may last 24–48 hours

  • Avoid intense physical activity for 24 hours unless directed otherwise

  • Apply ice or analgesics if recommended

  • Follow all instructions provided for stretching, exercise, or therapy

Patient Responsibilities

  • Comply with pre- and post-treatment instructions

  • Report adverse reactions immediately

  • Attend follow-up sessions as prescribed

Acknowledgment & Consent

I acknowledge that:

  • I have read and understood this consent form

  • I understand the benefits, risks, and alternatives of Shockwave Therapy

  • I consent to treatment and accept responsibility for my own safety

  • I release AI Wellness Center of Excellence, its staff, and affiliates from any liability, except in cases of gross negligence or willful misconduct

I consent to photographs or video for educational or promotional purposes, if applicable