NERVESYNC

EMG - Nerve Conduction Study Consent Form

EMG - Nerve Conduction Study Consent Form

Purpose of the Procedure:

This procedure is designed to evaluate the electrical activity of muscles and nerves. The test includes two parts: a Nerve Conduction Study (NCS) and a Needle Electromyography (EMG). The NCS involves recording electrical activity from your nerves using surface electrodes, while the Needle EMG assesses muscle activity by inserting a fine needle into the muscle.


Procedure Outline:

1. Preparation:

  • You may be asked to remove clothing, jewelry, hairpins, eyeglasses, hearing aids, or other mental objects that might interfere with the study.

  • If required to remove clothing, you will be provided with a gown for your comfort and privacy.

2. During the Nerve Conduction Study:

  • You will either sit or lie down, depending on the nerves being tested.

  • Recording electrodes will be attached over the nerve paths. A stimulating electrode will then be placed at a known distance away from these.

  • You will feel a mild and brief electrical shock when the stimulating electrode is activated,which is necessary to measure nerve function.

3. During the Needle EMG:

  • The neurologist will insert a very fine needle into several muscles to record their electrical activity. The needle insertion may cause some discomfort similar to that of an injection.

  • You may be asked to relax or slightly contract the muscle being tested. The electrical activity of the muscle will be recorded and analyzed.

4. Duration:

  • The entire procedure typically lasts between 30 to 90 minutes, depending on the number of nerves and muscles tested.


Potential Discomfort:

You may experience brief, minor discomfort during the electrical stimulation and needle insertion. Please inform the staff if the discomfort becomes intolerable.


Consent:

By signing below, you consent to undergo the Nerve Conduction Study and Needle EMG as described above. You acknowledge that you have been informed about the purpose, process,and potential discomforts associated with the procedure. You have been able to ask questions, and all your questions have been answered satisfactorily.

Purpose of the Procedure:

This procedure is designed to evaluate the electrical activity of muscles and nerves. The test includes two parts: a Nerve Conduction Study (NCS) and a Needle Electromyography (EMG). The NCS involves recording electrical activity from your nerves using surface electrodes, while the Needle EMG assesses muscle activity by inserting a fine needle into the muscle.


Procedure Outline:

1. Preparation:

  • You may be asked to remove clothing, jewelry, hairpins, eyeglasses, hearing aids, or other mental objects that might interfere with the study.

  • If required to remove clothing, you will be provided with a gown for your comfort and privacy.

2. During the Nerve Conduction Study:

  • You will either sit or lie down, depending on the nerves being tested.

  • Recording electrodes will be attached over the nerve paths. A stimulating electrode will then be placed at a known distance away from these.

  • You will feel a mild and brief electrical shock when the stimulating electrode is activated,which is necessary to measure nerve function.

3. During the Needle EMG:

  • The neurologist will insert a very fine needle into several muscles to record their electrical activity. The needle insertion may cause some discomfort similar to that of an injection.

  • You may be asked to relax or slightly contract the muscle being tested. The electrical activity of the muscle will be recorded and analyzed.

4. Duration:

  • The entire procedure typically lasts between 30 to 90 minutes, depending on the number of nerves and muscles tested.


Potential Discomfort:

You may experience brief, minor discomfort during the electrical stimulation and needle insertion. Please inform the staff if the discomfort becomes intolerable.


Consent:

By signing below, you consent to undergo the Nerve Conduction Study and Needle EMG as described above. You acknowledge that you have been informed about the purpose, process,and potential discomforts associated with the procedure. You have been able to ask questions, and all your questions have been answered satisfactorily.

NerveSync Pty Ltd

info@nervesync.com.au

19/3 Wexford Street

Subiaco, WA 6008

Opening Hours

Monday to Friday 8am - 5pm

NerveSync Pty Ltd

info@nervesync.com.au

19/3 Wexford Street

Subiaco, WA 6008

Opening Hours

Monday to Friday 8am - 5pm

NerveSync Pty Ltd

info@nervesync.com.au

19/3 Wexford Street

Subiaco, WA 6008

Opening Hours

Monday to Friday 8am - 5pm