Chiropractic care, like all forms of health care, while offering considerable benefit may also provide some level of risk. This level of risk is most often very minimal, yet in rare cases injury has been associated with chiropractic care. The types of complications that have been reported secondary to chiropractic care include sprain/strain injuries, irritation of a disc condition, and rarely, fractures. One of the rarest complications associated with chiropractic care, occurring at a rate between one instance per one million to one per two million cervical spine (neck) adjustments may be a vertebral artery injury that could lead to stroke.
Prior to receiving chiropractic care in this Chiropractic office, a health story and spinal examination will be completed. These procedures are performed to assess your overall health and, in particular, your spine health. These procedures will assist us in determining if chiropractic care is appropriate, or if any further examinations or studies are needed. In addition, they will help us determine if there is any reason to modify your care or provide you with a referral to another health care provider. All relevant findings will be reported to you along with a care plan prior to beginning care.
I understand and accept that there are risks associated with chiropractic care and give my consent to the examinations that the doctor deems necessary, and to the chiropractic care including spinal adjustments, as reported following my assessment.
I have read and agreed to the form "Informed Consent"
We are committed to the highest quality of care for all of our patients; therefore, we schedule all appointments in advance and make every attempt to confirm them advance. When we schedule your chiropractic visit, that time belongs to you and you deserve our undivided attention.
We value our relationship with you and want to be fair. We do understand we do not always have control over traffic and unexpected occurrences. However, if you are unable to keep an appointment the following will apply:
initial here* I will provide a 2-business day notice if I need to cancel.
initial here* I am aware that first time cancellations and no shows will be charged half of the visit fee.
initial here* I am aware that cancellations and No Shows will be charged the full price of the visit for second offense.
initial here* If I exceed three broken appointments within a 12-month period I will be required to pay the full non-refundable payment for service at the time of booking.
initial here* If I am more than 15 minutes late my appointment will be cancelled and I will be charged half the price of my appointment.
initial here* If I am late to my appointment, my treatment will not exceed the reserved time block.
initial here*Habitual tardiness will result in the inability to book future appointments.
initial here* It is my responsibility to make sure I have an up to date card on file.
By signing below, you have read, and understand this agreement.