• Brock Chiropractic

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  • Chiropractic Informed Consent

  • I hereby give my consent to the performance of diagnostic tests and procedures and chiropractic treatment or management of my condition(s).

    Chiropractic treatment or management of conditions almost always includes the chiropractic adjustment, a specific type of joint manipulation. Like most health care procedures, the chiropractic adjustment carries with it some risks. Unlike many such procedures, the serious risks associated with the chiropractic adjustment are extremely rare. Following are the known risks:

    • Temporary soreness or increased symptoms or pain. It is not uncommon for patients to experience temporary soreness or increased symptoms or pain after the first few treatments.
    • Dizziness, nausea, flushing. These symptoms are relatively rare. It is important to notify the chiropractor if you experience these symptoms during or after your care.
    • Fractures. When patients have underlying conditions that weaken bones, like osteoporosis, they may be susceptible to fracture. It is important to notify your chiropractor if you have been diagnosed with a bone weakening disease or condition. If your chiropractor detects any such condition while you are under care, you will be informed and your treatment plan will be modified to minimize risk of fracture.
    • Disc herniation or prolapse. Spinal disc conditions like bulges or herniations may worsen even with chiropractic care. It is important to notify your chiropractor if symptoms change or worsen.
    • Stroke. A certain extremely rare type of stroke has been associated with chiropractic care. Although there is an association between this type of stroke and chiropractic visits, there is also an association between this type of stroke and primary care medical visits. According to the most recent research, there is no evidence of excess risk of stroke associated with chiropractic care.
    • The increased occurrence of this type of stroke associated with both chiropractic and medical visits is likely explained by patients with neck pain and headache consulting both doctors of chiropractic and primary care medical doctors before their stroke.
    • Other risks associated with chiropractic treatment include rare burns from physiotherapy devices that produce heat.

    I understand that the practice of chiropractic, like the practice of all healing arts, is not an exact science, and I acknowledge that no guarantee can be given as to the results or outcome of my care.

    I have read or had read to me this informed consent document. I have discussed or been given the opportunity to discuss any questions or concerns with my chiropractor and have had these answered to my satisfaction prior to my signing this informed consent document. I have made my decision voluntarily and freely.

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  • Massage Therapy Informed Consent

  • Please take a moment to read & initial all following statements:

    I understand & accept that I will be charged the FULL PRICE for broken appointments without proper 24hr notice; including rescheduled or canceled appointments and no shows.    
     
    I understand that arriving late may require the therapist to shorten the length of my treatment with full charges applied, so that other clients are not inconvenienced.    
     
    I agree to inform the therapist of any changes in my health. By signing this release, I hereby waive and release my therapist from any & all liability, past, present and future relating to massage therapy.    
     
    If I experience pain or discomfort during the session, I will immediately inform my therapist so that the pressure can be adjusted. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.    
     
    I understand that massage therapy is given for the purpose of stress reduction, relief from muscular tension or spasm, and for increasing circulation and energy flow. Massage services are designed to be a health aid and are in no way to take the place of doctor's care. Information exchanged during any massage session is educational in nature and intended to help me become more familiar and conscious of my own health status and is to be used at my own discretion. Information shared with your therapist is completely confidential.    
     
    I understand that the massage therapist does not diagnose illness, disease or any other physical or mental disorder. As such, the massage therapist does not prescribe medical treatment or pharmaceuticals, nor does she perform any spinal manipulations. It is clear to me that massage therapy is not a substitute for medical diagnosis and treatment and I should see a physician for any ailments I might have.    
     
    Because massage is contraindicated (should not be performed) under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the therapist updated as to any change in my medical profile and understand there shall be no liability on the therapist's part should I fail to do so.

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