Chiropractic Informed Consent:
A patient, seeing a chiropractor, gives the doctor permission and authority to care for the patient in accordance with the chiropractic tests, diagnosis, and analysis. The chiropractic adjustment or other clinical procedures are usually beneficial and seldom cause any problems. In rare cases, underlying physical defects, deformities or pathologies may render the patient susceptible to injury. The doctor, of course, will not give any treatment or care if he/she is aware that such care may be contra-indicated. Again, it is the responsibility of the patient to make it known, or to learn through healthcare procedures what he/she is suffering from: latent pathological defects, illnesses or deformities which would otherwise not come to the attention of the chiropractic physician. The chiropractic doctor provides a specialized, non-duplicating health care service. Your doctor of chiropractic is licensed in a special practice and is available to work with other types of providers in your health care regimen. I understand that if I am accepted as a patient by a chiropractor at Portland Family Chiropractic, I am authorizing them to proceed with any treatment they deem necessary. Furthermore, any risk involved, regarding chiropractic treatment, will be explained to me upon my request.
It is important that you understand, results are not guaranteed, and there is no promise to cure. As with all types of healthcare interventions there are some risks to care, but please rest assured that all precautionary measures, diagnostic tests, and orthopedic testing will be done and with consent, performed to minimize any risks. These risks include, but are not limited to: muscle spasms, aggravating and or temporary increase in symptoms, lack of improvement of symptoms, fractures, disc injuries, strokes, dislocation, strains and sprains. With respect to strokes, there is a rare but serious condition known as an “arterial dissection” that typically is caused by a tear in the inner layer of the artery that may cause the development of a clot with the potential to lead to stroke. The best available scientific evidence supports the understanding that chiropractic adjustments do not cause a dissection in a normal healthy artery. Disease processes, genetic disorders, medications and vessel abnormalities may cause an artery to be more susceptible to dissection.
The reported association between chiropractic visits and stroke is exceedingly rare and is
estimated to be related in one in one million to one in two million cervical adjustments.
We do not offer to diagnose or treat any condition other than vertebral subluxations. However, if during the course of a chiropractic spinal evaluation, we encounter non-chiropractic findings, we will advise you. If you desire advice, diagnosis or treatment for those findings, we will recommend you seek a specialist in that field. Our only practice objective is to eliminate vertebral subluxations. By signing below you are authorizing the treatment and understand the information offered above. Your signature also allows our office to release any information offered above and consent to treatment based on the doctor's recommendations. By signing below you understand that this is not a medical diagnosis center but a chiropractic office in which the main focus is to correct spinal subluxations and to reduce pain and improve quality of life so you can function better. Our staff does not diagnose severe illness, disease or any physical or mental condition, nor do they prescribe medication.