Consent to Chiropractic Care
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.
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.
Fees for Service
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.
Consent to AI-Assisted Recording of Consultations
I understand that my consultation may be audio recorded using AI-assisted technology to assist with clinical documentation, note-taking, record keeping, quality assurance, and the provision of healthcare services.
I consent to the collection, use, and storage of these recordings, together with any transcripts, summaries, notes, or other information generated through the use of artificial intelligence systems, as part of my healthcare record.
I understand that recordings and related information may be stored electronically using secure cloud-based systems and service providers engaged by the practice. The practice will take reasonable steps to protect my personal information in accordance with the Privacy Act 1988 (Cth), the Australian Privacy Principles, and any applicable state or territory privacy and health records legislation.
I understand that authorised members of the practice and its contracted service providers may access recordings and AI-generated documentation where necessary for the purposes of providing healthcare services, maintaining records, improving service quality, or meeting legal and regulatory obligations.
I understand that I am not required to consent to the recording of my consultation and that I may decline or withdraw my consent to recording at any time before or during the consultation by informing the practitioner. If I choose not to be recorded, the consultation will proceed using alternative methods of clinical documentation where reasonably practicable.
By signing this consent form, I acknowledge that I have read and understood this information and voluntarily consent to the recording, processing, and storage arrangements described above.
Consent to The Use of Security Cameras
I understand that video cameras are in use within the practice for practitioner and staff safety, security, incident management, and the protection of patients, practitioners, and practice property.
I understand that these cameras record video images only and do not record audio conversations.
I understand that any video footage captured by these cameras is stored locally on secure practice systems and is not used for clinical recording, consultation documentation, or AI-assisted note-taking purposes.
I understand that access to video footage is restricted to authorised personnel and that any collection, storage, use, and disclosure of footage will be managed in accordance with applicable privacy and health records legislation.
By signing this consent form, I acknowledge that I have been informed of the use of security cameras within the practice and understand the purpose and handling of any video footage that may be recorded.