The doctor after examination has explained the prescribed treatment plan to me (for myself or for my minor child) including the nature and purpose of the chiropractic adjustments as well as other treatments or procedures appropriate for the condition. I hereby request and consent to treatment from ADVANCED CHIROPRACTIC CLINIC, P.C. doctors and staff including chiropractic adjustments, manual therapy techniques and physical modalities including hydroculation (heat), cryotherapy (ice), ultrasound, neuromuscular reeducation, massage, rehab, examinations or other treatments and testing that the doctor determines to be appropriate for my condition or for my minor child’s condition.
In particular you should note:
While rare, some patients have experienced rib fractures, muscle strains and/or ligament sprains
There have been reported cases of injury to a vertebral artery following
cervical spinal adjustments
. Vertebral artery injuries have been known to cause stroke, sometimes with serious neurological impairment, and may on rare occasion result in death.
Hydroculation (heat) and cyrotherapy (ice):
skin reactions or burns
Chiropractic treatments, including spinal adjustments, have been the subject of government reports and multi-disciplinary studies conducted over many years and have been demonstrated to be highly effective treatment for spinal pain, headaches being and other similar symptoms. The risk for injuries or complications from chiropractic treatment is substantially lower than that associated with many medical or other treatments, medications, and procedures given for the same symptoms.
I acknowledge I have discussed, or have had the opportunity to discuss, with my doctor the nature and purpose of the treatments in general and myself or my minor child’s treatment in particular (including spinal adjustments) as well as the contents of this Consent and I fully understand that there are no guarantees in medicine as to the outcome of any treatment. I consent to the treatment offered or recommended to me for myself or my minor child including spinal adjustments. I intend this consent to apply to all of my or my minor child’s present and future care.
I understand and am informed that, as with any medical treatment and care, in the practice of chiropractic there are some risks. I do not expect the doctor to be able to anticipate and explain all risks and complications. I wish to rely on the doctor to exercise judgment during the course of treatment and procedures that the doctor feels appropriate for me at the time based on the facts know at the time, in my or my minor child’s best interest.