Softwave Consent Form

Extracorporeal Shockwave Therapy Patient Consent Form 

Suitability for ESWT (Extracorporeal Shockwave Therapy), also known as Softwave Tissue Regeneration Technologies. 

By answering the following questions, you will assist us to decide if you are suitable for ESWT. 

Have you been injected with cortisone this month?
Are you using a cardiac pacemaker?
Do you have cancer/tumor?
Do you have a skin infection?
Are you pregnant or do you suspect you may be pregnant?
Are you under 16 years of age?
Do you have any history of tinnitus?

RISK OF THIS PROCEDURE

A) Pain and Soreness. This is temporary and resolves after a few days. 

B) The FDA has labeled this a "Non-Significant Risk" Therapy. 

Consent for Procedure 

I have been fully informed of ESWT which the use of has been fully explained to me by my treating physician/staff, and I fully understand the nature of this treatment. I also confirm I have been given the opportunity to discuss and clarify any concerns and that no guarantees have been made to me mostly for pain relief and may offer an improvement of function. I also understand foregoing treatment is not the first option for my condition and an alternate treatment has either already been provided or offered to me. 

Thank you for taking the time to fill out this form.

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Monday

10:00 am - 1:00 pm

3:00 pm - 6:00 pm

Tuesday

8:00 am - 11:00 am

Wednesday

10:00 am - 1:00 pm

3:00 pm - 7:00 pm

Thursday

9:00 am - 1:00 pm

3:00 pm - 6:00 pm

Friday

Closed

Saturday

9:00 am - 11:00 am

Sunday

Closed

Monday
10:00 am - 1:00 pm 3:00 pm - 6:00 pm
Tuesday
8:00 am - 11:00 am
Wednesday
10:00 am - 1:00 pm 3:00 pm - 7:00 pm
Thursday
9:00 am - 1:00 pm 3:00 pm - 6:00 pm
Friday
Closed
Saturday
9:00 am - 11:00 am
Sunday
Closed