MEDITONE CONSENT FORM What is radial shockwave therapy and how does it work?Radial Shockwave Therapy is a series of high-energy percussions to the affected area. The shockwave is a physical sound wave "shock", not an electric one.Treatment produces an inflammatory response. The body responds by increasing metabolic activity around the site of pain. This stimulates and accelerates the healing process (promotes the remodelling of dysfunctional collagenous tissues, such as tendinopathies, trigger points, muscle strains, etc.).Shockwaves break down scar tissue and/or calcification and the transmission of pain is diminished through neurological mechanisms (inhibition of nociceptors)What are the benefits of Shockwave Treatment?This therapy stimulates the body's natural self-healing process. There is actually an immediate reduction of pain and improved range of motion. ESWT may also eliminate your need for surgery.How long does the treatment last?Approximately 2000 shocks are administered per treatment area (the duration of which is approximately 5 minutes). Some patients and/or conditions require more shocks and duration, depending on severity and chronicity (how long the condition or injury has existed).How many treatments will I need?Normally three to five treatments are necessary at intervals at determined by your Practitioner; there is a small possibility that 2 or more additional treatments may be necessary if your condition is very chronic. Should you not respond in this time, your case will be reviewed to determine an appropriate referral. Success rates with ESWT are unparalleled (over 80 to 90% improvement).It is recommended to have 1 treatment per week, or within 72 hours for the first 3 treatments. Then 1 treatment every 2 weeks, for another 2 treatments, to be followed by a maintenance program on a monthly basis if required. Treatment cost is $82.50 per area for Shockwave Treatment cost is $82.50 per area Laser Therapy $165 per area for both Shockwave & Laser Therapy combined. Ultratone biostimulation (TENS & EMS) is complimentary when used in conjunction with Dolorcast Shockwave and Laser therapy. Medical Therapeutic Rehabilitation with Ultratone Biostimulation is $110 when done outside of other treatments GST included in above pricing
Does the treatment hurt?It is a short treatment (usually five to twenty minutes) that may be fairly uncomfortable. However, most people are able to easily tolerate it. However, if you cannot tolerate it, adjustments on the machine can decrease the pressure you feel.Will it hurt after the treatment?There may or may not be immediate pain, but some discomfort may be experienced2-4 hours after the treatment. In some cases it can last up to 48 hours and in very rare cases, the pain lasted up to 5 days. Some bruising and swelling can occur.
What should I do if I am in pain after the treatment?The shockwave will trigger an inflammatory response, which is the body's natural process of healing. For this reason, do not use anti-inflammatory medications. Do not use ice. The pain should subside within 24 hours.What if it feels good after the treatment?Even if it feels good, we recommend decreased activity for 48 hours following the treatment.What is the success rate of this kind of treatment?A successful treatment is considered as a patient having at least 75% reduction in pain within 3 months. Worldwide, success rates are around 80 to 90%.Are there contraindications and/or precautions?Contraindications include:• Coagulation disorders, thrombosis, heart or circulatory patients• Use of anticoagulants, especially Marcumar, Heparin, Coumadin• Tumour diseases, carcinoma, cancer patients• Pregnancy• Polyneuropathy in case of diabetes mellitus• Acute inflammations / pus focus in the target area• Children in growth• Cortisone therapy up to 6 weeks before first treatmentSide effects include: (These side effects generally abate after 5 to 10 days.)• Swelling, reddening, haematomas• Petechiae, bruising• Pain• Skin lesions (especially after previous cortisone therapy)Why am I asked to sign a consent form?Pain can increase temporarily. Bruising and or swelling are also possible. We want you to be informed of all aspects. By signing the below, you acknowledge that you understand and accept the risks, benefits and costs of shockwave therapy, and consent to having this therapy administered.
NAME: _____________________________ SIGNATURE: ________________________
DATE: ___________________
Does the treatment hurt?It is a short treatment (usually five to twenty minutes) that may be fairly uncomfortable. However, most people are able to easily tolerate it. However, if you cannot tolerate it, adjustments on the machine can decrease the pressure you feel.Will it hurt after the treatment?There may or may not be immediate pain, but some discomfort may be experienced2-4 hours after the treatment. In some cases it can last up to 48 hours and in very rare cases, the pain lasted up to 5 days. Some bruising and swelling can occur.
What should I do if I am in pain after the treatment?The shockwave will trigger an inflammatory response, which is the body's natural process of healing. For this reason, do not use anti-inflammatory medications. Do not use ice. The pain should subside within 24 hours.What if it feels good after the treatment?Even if it feels good, we recommend decreased activity for 48 hours following the treatment.What is the success rate of this kind of treatment?A successful treatment is considered as a patient having at least 75% reduction in pain within 3 months. Worldwide, success rates are around 80 to 90%.Are there contraindications and/or precautions?Contraindications include:• Coagulation disorders, thrombosis, heart or circulatory patients• Use of anticoagulants, especially Marcumar, Heparin, Coumadin• Tumour diseases, carcinoma, cancer patients• Pregnancy• Polyneuropathy in case of diabetes mellitus• Acute inflammations / pus focus in the target area• Children in growth• Cortisone therapy up to 6 weeks before first treatmentSide effects include: (These side effects generally abate after 5 to 10 days.)• Swelling, reddening, haematomas• Petechiae, bruising• Pain• Skin lesions (especially after previous cortisone therapy)Why am I asked to sign a consent form?Pain can increase temporarily. Bruising and or swelling are also possible. We want you to be informed of all aspects. By signing the below, you acknowledge that you understand and accept the risks, benefits and costs of shockwave therapy, and consent to having this therapy administered.
NAME: _____________________________ SIGNATURE: ________________________
DATE: ___________________