List your major complaints in order of severity and please indicate how long you have had this complaint.

When a person enters this office for care, it is essential that we are both working towards the same objectives.
Chiropractic has only one objective. It is important for us to establish a clear understanding of the philosophy and procedures of this office so that there is no confusion.

Health: A state of optimal physical, social, and mental well-being and not just merely the absence of disease or symptoms. Without interference, the nervous system is able to coordinate all the body's systems and functions.

Adjustment: A specific force applied to the body in order to allow the body to heal itself. The purpose of the chiropractor is to remove the irritation to the nervous system and unlock the healing potential of the body.

Vertebral Subluxation: Accidents and injuries create a weakness in the body that allows the spine to lock in a stressed position. This stressed position leads to imbalances in the spine showing up as postural distortion, and leads to nervous imbalance.

Subluxated spine: Once the spine moves into a stressed position the entire spine is affected, showing spinal distortions and creating pressure on the spinal cord. This interference can lead to abnormal function anywhere in the body.

Diagnosing and treating disease (or its symptoms) is the practice of medicine. Chiropractic is not medicine and does not diagnose or treat disease. At Precise Chiropractic we are concerned with adding health to the body, not treating the lack of it. Whatever stage of health you are in, you can benefit from a properly functioning nervous system. If during your care we find something out of the ordinary, we will notify you. If it is not Chiropractic in nature it will be your responsibility to seek care with the appropriate professional.

Our objective is to balance your spine, thus removing nervous system interference and allowing the body to heal itself and function at 100% of its potential.

"I understand the above statement and choose to accept care under these terms"

Precise Chiropractic Notice of Privacy Practices Acknowledgement

Precise Chiropractic 4101 John R. Rd. Ste 300 Troy, MI 48085 (248) 680-7200

I understand that under the Health Insurance Portability and Accountability Act (HIPAA), I have certain rights to privacy regarding my protected health information. I acknowledge that I have received or have been given the opportunity to receive a copy of your Notice of Privacy Practices. I also understand that this practice has the right to change its Notice of Privacy Practices and that I may contact the practice or visit our website at www.nuccainfo.com at any time to obtain a current copy of the Notice of Privacy Practices.