Collect electronic waivers for medical on computer browsers.

My physician assistant has explained to me the nature, purpose and possible consequences of each treatment or procedure as well as the significant risks involved, possible complications and possible alternative methods of treatment.

Some of the possible risks and complications associated with the injection therapy include bleeding, infection, temporary and/or permanent nerve damage, spinal cord injury, blood vessel damage, pain at the injection site, severe headache, seizures, muscle damage, joint injury, tendon injury, allergic reaction to medication, unexpected reaction to medication, vasovagal reaction (fainting), worsened pain, temporary and/or permanent weakness in an extremity, collapsed lung, bruising at injection site, discoloration of skin at injection site, local fat loss at injection site, and remote risk of death.

Some of the possible benefits of injection therapy include lowered pain level, decreased use of medications, increased ability to participate in physical therapy, return to work tolerance and decreased reliance on medical care.

Full Circle Pain Management may use techniques and procedures that are considered to be investigational or experimental. In many cases, these techniques and procedures are still considered standard of care due to proven safety and effectiveness.

I understand that the explanation I have received is not exhaustive and that there may be other, more remote risks and consequences. I have been advised that a more detailed explanation will be given to me if I so desire. I do not want further explanation. I understand that any questions I have regarding my treatment should be discussed and that it is my responsibility to voice any concerns or questions to my practitioner.

No Guarantee of Results: I understand that no guarantee or assurance has been given by anyone as to the results that may be obtained.