Our goals are to provide a detailed assessment of your current health status and provide you with a guide to a sustainable approach to reaching your health goals and achieving a healthy nervous system. By submitting this form and affixing your signature, you hereby grant Spinal Care Chiropractic Inc. permission to collect personal data from you for the purpose of conducting patient evaluation. You also hereby grant permission to receive a chiropractic evaluation including history taking, postural and gait analysis and other pertinent examination procedures. Any findings will be communicated before commencement of care, if appropriate. Verbally agreeing to start treatment whether on the day of consultation or not, automatically grants our chiropractor the permission to perform chiropractic adjustments or other appropriate forms of treatment as required. Treatment may only start once patient has submitted all necessary X-Rays or other medical tests required. The decision to grant a patient's request to have treatment the same day as the initial consultation is at the discretion of the chiropractor. Consult and treatment fees will be charged accordingly (as per current price list) and must be settled on or before the day of appointment. Original patient files submitted for evaluation such as but not limited to X-Rays and MRI (CD or film) will be returned after evaluation. Should you decide not to pursue follow-up consultations or treatment, kindly collect your CDs or films within three (3) months from your last appointment. Failure to collect within the specified time automatically grants Spinal Care Chiropractic Inc. permission to destroy the records on your behalf. For minors or incapacitated patients, kindly affix the signature of the person consenting on their behalf. Submission of this form signifies your consent as well agreement to the above terms and conditions.