Informed Consent Injection Therapy
Erica Boulangée M.Ac, L.Ac, LMT
Whenever a needle is introduced though the skin, inherent risks are present. Although the risks are small, the expected benefit from the procedure must outweigh the possible risks. Make sure that you have a thorough understanding of the expected benefit from the injection. The risks of injection depend on where the injection is made and what is being injected. If the injection is made in a large muscle, the risk of hitting vital structures is very small. Injections in the area of neurovascular bundles (where nerves, veins, and arteries travel together) have a higher risk of injury, and injections in the area of the lung organs have a higher risk of injuring them.
The risks of injection are:
INFORMED CONSENT AND AGREEMENT
I hereby request and consent to injection therapy on my body, in order to enhance the effect of stimulating an acupuncture point. I understand that I will only be injected with substances that fall within the scope of practice of Licensed Acupuncturists in Colorado. I understand the risks involved. I do not expect my practitioner to be able to anticipate all risks and complications. By signing this form, I agree to accept all risks and release all liabilities from Erica Boulangée L.Ac., her apprentices, and Beyond Massage Inc.
I have read and understand this document
Leave this empty:
If you have questions about the contents of this document, you can email the document owner.
Document Name: Informed Consent Injection Therapy
Agree & Sign