I consent to receive chiropractic assessment and treatment.
I understand that chiropractic care is generally considered safe and effective, but like all healthcare treatments, it carries some risks. Common reactions may include temporary soreness, stiffness, bruising, dizziness, fatigue, or a short-term aggravation of symptoms.
I understand that rare but more serious complications can occur, including strains or sprains, disc injuries, fractures, nerve irritation, worsening of an underlying condition, and, in very rare cases, stroke or stroke-like symptoms associated with neck treatment.
My Chiropractor has explained the nature, benefits, and potential risks of the proposed care, and I have had the opportunity to ask questions. I understand that no treatment outcome can be guaranteed and that not all risks or complications can be predicted.
I understand the importance of providing complete and accurate information about my health history and current condition, as this may affect my care.
I understand that I may withdraw my consent at any time, either completely or for specific procedures or areas of the body.
I understand that consultation appointments, such as initial testing and X-ray reports are $60, treatment appointments are $125 and a consultation with treatment is $185 and I agree to pay the applicable fees for services provided.
By signing below, I confirm that I understand the information provided, have had my questions answered to my satisfaction, and consent to proceed with chiropractic care.