---
title: Electrical Muscle Stimulation Consent Form Template | Paperform
description: Professional EMS therapy consent form template with contraindication screening, treatment authorization, and eSignature support. Perfect for physical therapy, chiropractic, and rehabilitation clinics.
url: "https://paperform.co/templates/therapeutic-electrical-muscle-stimulation-consent-form"
type: static
generatedAt: "2026-03-28T00:45:23.675Z"
---

[← Back to free form templates](/templates/)    ![Therapeutic Electrical Muscle Stimulation Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/therapeutic-electrical-muscle-stimulation-consent-form.png)
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### Professional Electrical Muscle Stimulation Consent Forms for Healthcare Providers

Electrical muscle stimulation (EMS) therapy is a valuable treatment modality used by physical therapists, chiropractors, sports medicine clinics, and rehabilitation facilities. However, proper patient screening and informed consent are essential to ensure safe, effective treatment. This **therapeutic electrical muscle stimulation consent form template** streamlines your intake process while protecting both practitioners and patients.

#### Why Digital EMS Consent Forms Matter

Traditional paper consent forms create administrative bottlenecks, risk getting misplaced, and make it difficult to track compliance. With Paperform, you can create a professional, branded consent form that:

 - **Screens for contraindications automatically** using conditional logic to flag high-risk patients
 - **Collects eSignatures** through Papersign integration for legally binding authorization
 - **Syncs with your practice management software** via integrations with popular healthcare platforms
 - **Maintains HIPAA-aligned workflows** when paired with appropriate security measures

This template is designed specifically for healthcare providers who administer electrical muscle stimulation, including TENS (transcutaneous electrical nerve stimulation), EMS (electrical muscle stimulation), and NMES (neuromuscular electrical stimulation) therapies.

#### What's Included in This EMS Consent Form

This comprehensive template covers all essential elements of informed consent for electrical muscle stimulation:

**Patient Information Collection** – Capture complete contact details, date of birth, and emergency contact information to maintain accurate patient records.

**Medical History Screening** – Identify contraindications including pacemakers, pregnancy, epilepsy, malignancy, metal implants, and other conditions that may preclude safe EMS therapy.

**Treatment Area Documentation** – Record the specific body regions requiring treatment and the therapeutic goals, ensuring clear communication between practitioner and patient.

**Procedure Explanation** – Provide clear, plain-language descriptions of how EMS therapy works, what sensations patients should expect, and typical treatment duration.

**Risks and Benefits Disclosure** – Document that patients understand potential side effects (skin irritation, muscle soreness) alongside expected therapeutic benefits (pain relief, improved circulation, muscle re-education).

**Patient Rights and Responsibilities** – Clarify that patients can refuse or discontinue treatment at any time and must communicate discomfort immediately during sessions.

**Authorization and Consent** – Collect legally binding eSignatures confirming informed consent before proceeding with therapy.

#### Perfect for Multiple Healthcare Specialties

This electrical muscle stimulation consent form serves various healthcare practices:

 - **Physical Therapy Clinics** managing post-surgical rehabilitation, sports injuries, and chronic pain
 - **Chiropractic Offices** incorporating EMS as part of comprehensive treatment plans
 - **Sports Medicine Facilities** using EMS for athletic recovery and performance enhancement
 - **Rehabilitation Centers** employing NMES for neuromuscular re-education after stroke or injury
 - **Pain Management Practices** offering TENS therapy for chronic pain conditions
 - **Athletic Training Departments** at schools, universities, and professional sports organizations

#### Streamline Your Practice with Paperform

Moving your EMS consent forms online with Paperform offers significant advantages over paper-based systems:

**Improved Patient Experience** – Patients can complete forms on their own devices before arriving for their appointment, reducing wait times and paperwork fatigue. The clean, professional design works seamlessly on phones, tablets, and computers.

**Conditional Logic for Safety** – Automatically route patients with contraindications to additional screening questions or flag their submissions for practitioner review before treatment proceeds.

**Automated Record-Keeping** – Every submission is automatically saved, searchable, and accessible to authorized staff. No more filing cabinets or lost paperwork.

**Integration with Practice Management** – Connect your consent forms to your existing EMR, CRM, or scheduling system using Paperform's native integrations or through Stepper workflows that can automatically create patient records, send appointment confirmations, and update treatment schedules.

**Compliance Documentation** – Maintain clear audit trails showing when forms were completed, by whom, and what information was provided at the time of consent—critical for regulatory compliance and legal protection.

#### Enhanced Workflows with Stepper

Take your EMS consent process further by connecting it to [Stepper](https://stepper.io), Paperform's AI-native workflow automation platform. When a patient submits their consent form, Stepper can:

 - Automatically check for contraindications and route high-risk patients to a physician approval workflow
 - Create or update patient records in your practice management software
 - Send pre-treatment instructions and educational materials via email or SMS
 - Schedule follow-up appointments based on treatment protocols
 - Trigger billing processes and insurance documentation
 - Notify practitioners when new consents are ready for review

These automated workflows mean your administrative staff spends less time on manual data entry and more time supporting patient care.

#### Legally Binding Digital Signatures with Papersign

For consent forms, a simple checkbox isn't enough—you need legally binding authorization. That's where [Papersign](https://papersign.com) comes in. Once a patient completes your EMS consent form, Papersign automatically generates a formatted consent document and sends it for secure electronic signature.

Papersign provides:

 - **Legally compliant eSignatures** meeting industry standards for healthcare authorization
 - **Audit trails** documenting who signed, when, and from what IP address
 - **Automatic storage** of fully executed consent documents linked to the original form submission
 - **Multi-party signing** when both practitioner and patient signatures are required

This integration transforms your Paperform submission into a complete, signed consent document without requiring separate document management systems.

#### Customization for Your Practice

While this template provides a solid foundation, you can easily customize it to match your specific needs:

 - **Add your practice branding** with custom colors, fonts, logos, and background images
 - **Include specific treatment protocols** unique to your therapeutic approach
 - **Integrate with your existing systems** including Mindbody, Jane App, Cliniko, or other healthcare platforms
 - **Add payment collection** if you charge consultation fees or require deposits for treatment packages
 - **Create multiple versions** for different treatment types (TENS vs. NMES) or patient populations (pediatric vs. adult)

Paperform's intuitive editor makes these customizations straightforward—no coding or design skills required.

#### Built for Healthcare Professionals Who Value Efficiency

Healthcare providers choose Paperform because it respects both their time and their patients' experience. Whether you're a solo practitioner or managing a multi-location clinic, this EMS consent form template helps you:

 - **Reduce administrative burden** by eliminating paper forms and manual filing
 - **Improve compliance** with consistent, thorough documentation
 - **Enhance patient safety** through systematic contraindication screening
 - **Protect your practice** with legally sound consent procedures
 - **Scale smoothly** as your practice grows without adding administrative complexity

Trusted by healthcare providers worldwide and featuring enterprise-grade security including SOC 2 Type II compliance, Paperform gives you the professional tools you need with the simplicity you want.

#### Get Started Today

This therapeutic electrical muscle stimulation consent form template is ready to use immediately. Simply customize it with your practice information, add your branding, and share it with patients via direct link, email, or embed it on your website. With Paperform's free plan, you can start improving your consent process today, then upgrade as your needs grow.

Transform your patient intake from a paperwork hassle into a smooth, professional experience that sets the right tone for quality care.
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