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Run: Dry Needling Treatment and Consent Log

Track each dry needling session, consent discussion, needle placement, patient tolerance, and post-treatment adverse event screening in one log. Use it to st...

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Session Details

Treatment date (required)

Provider name (required)

Clinic location

Body region treated (required)

If other, specify body region

Informed Consent

Informed consent discussed before treatment (required)

Yes No N/A

Patient provided informed consent (required)

Consent method (required)

Risks and expected effects explained (required)

If other, specify risk or disclosure

Consent notes

Optional brief note if the patient asked questions or additional disclosure was provided. Avoid unnecessary PII.

Needling Treatment Details

Number of needles used (required)

Needle insertion sites (required)

List the anatomical sites treated. Use concise clinical terms and avoid unnecessary identifiers.

Technique notes

Optional brief note on trigger point response, needle retention time, or other clinically relevant observations.

Patient tolerance during treatment (required)

Post-Treatment Response and Adverse Event Screening

Immediate patient response (required)

Post-treatment adverse event screening completed (required)

Yes No N/A

Any adverse events or complications observed (required)

Adverse event types

If other, describe adverse event

Follow-up actions or patient instructions

Document any monitoring, education, referral, or escalation provided after treatment.

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Email (required)

Your name (optional)

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