Fees & Payments

• Private: R700 (card only).
• Medical aid: R800 (contracted with most schemes).
• Cashless & paperless: We accept card payments only — no cash, cheques, or EFTs.
• Claims & statements: We’ll claim on your behalf (where supported) or provide an itemised statement for your medical aid.
• Tariffs & shortfalls: Our pricing aligns with the latest Chiropractor Medical Aid Tariffs — not all medical aids/schemes cover chiropractic services in full; any excess or outstanding amount is due immediately on completion of the visit.

What to Expect (15–30 minutes)

• A focused assessment and a personalised treatment plan.
• Specific, gentle, targeted spinal manipulation and evidence-based adjuncts as indicated.
• We do not perform generalized “multi-cracking” adjustments.
• Children under 12 (including infants): Please consult a paediatric chiropractor with specialised training in children’s musculoskeletal care.
• Pregnant patients: Please consult a prenatal chiropractor (e.g., a practitioner with additional pregnancy-care training).
• We do not provide pregnancy-specific or paediatric-specific treatments, but we’re happy to refer you to an appropriately qualified provider.

Before Your Visit

• Please arrive 10 minutes early.
• Complete this Online Patient Intake Form.
• Road accident or 3rd-party claim? Please also complete the RAF Add-On Intake Form (link in your confirmation/thank-you page).

Privacy & Professional Standards

• For patient privacy and professional ethics, no photography or video recording of consultations or treatments is permitted.

Questions?

If you need any clarification or assistance, contact us via capetownchiropractor.co.za.

*Note: The parent or legal guardian must complete these fields and sign if the patient is under eighteen (18) years of age.

I, the undersigned, do consent to chiropractic treatment, including but not limited to: chiropractic spinal manipulation or adjustments, chiropractic joint manipulation and mobilization, spinal traction therapy, dry needling, electro dry needling, percussion device therapy, therapeutic taping, local cryostimulation-cryotherapy, Extracorporeal shockwave therapy, and laser therapy; which may have some risks, side-effects, adverse effects and complications although uncommon, which will be explained by my Chiropractor.

*The parent or legal guardian must sign if the patient is under eighteen (18) years of age.

BY SIGNING BELOW I CONSENT TO THE PERFORMANCE OF CHIROPRACTIC ADJUSTMENTS-SPINAL MANIPULATION AND OTHER THERAPEUTIC PROCEDURES INCLUDING BUT NOT LIMITED TO JOINT MANIPULATION AND MOBILIZATION, SPINAL TRACTION THERAPY, DRY NEEDLING, ELECTRO DRY NEEDLING, PERCUSSION DEVICE THERAPY, LASER THERAPY, EXTRACORPOREAL SHOCKWAVE THERAPY, LOCAL CRYOTHERAPY-CRYOSTIMULATION AND THERAPEUTIC TAPING ON ME (OR ON THE ABOVENAMED PATIENT FOR WHOM / AM LEGALLY RESPONSIBLE) BY DR A.A. VICTOR AND HIS ASSOCIATE(S) WHO NOW AND IN THE FUTURE MAY CARE FOR ME IN THIS OFFICE.

I understand that, as in the practice of medicine and other health disciplines, the practice of chiropractic, including spinal manipulation, joint manipulation, and mobilization and spinal traction therapy, may also present some risks, side-effects, adverse effects, and complications, although uncommon, including but not limited to post-soreness, post-stiffness, sprain, strain, fractures, dislocations, and general aggravations of an inflammatory nature or pain. In addition, the practice of additional therapeutic procedures including but not limited to percussion device therapy, laser therapy, Extracorporeal shockwave therapy, local cryostimulation-cryotherapy, dry needling, electro dry needling, and therapeutic taping may also present some risks, side- effects, adverse effects, and complications, although uncommon, including but not limited to post-soreness, post-stiffness, allergic reaction, cryotherapy-induced frostbite, dry needling-induced pneumothorax, and general aggravations of an inflammatory nature or pain.

Reports have documented injury cases to a vertebral artery following neck mobilization and manipulation. Such vertebral artery injury may result in serious neurological injury or stroke. However, this complication is an infrequent event occurring approximately once per two million treatments. In addition, there have been reported cases of disc injuries following spinal manipulative therapy, although no scientific study has ever demonstrated such damages caused by manipulative techniques.

I acknowledge and understand that my Chiropractor will screen me for indications to determine whether I am a candidate for chiropractic spinal manipulation or adjustments or any other therapeutic procedures and treatments offered to the best of his ability. I do not expect the doctor to anticipate all risks, side-effects, adverse effects, and complications during the procedure(s) and treatment(s) that the doctor feels at the time, based upon the facts then known, are in the best interest. However, I acknowledge and understand that I will have an opportunity to discuss with the doctor or their associate the nature and purpose of the chiropractic procedures, based upon the facts then known and considered in my best interest.

I understand that the results of all services offered are not guaranteed. With respect to the services to be rendered to me pursuant to this agreement, I agree that Dr. A A Victor and/or his associate will not be held liable for any harm to me or to my dependents, howsoever caused, whether or not arising out of their negligence.

I understand that not all medical aids and medical aid schemes cover chiropractic services, consultations, and treatments. In the case of insufficient cover by the medical aid or medical aid scheme, the excess fee or total amount owed is due and payable immediately upon completion of the service. I acknowledge and understand that the Chiropractor will discuss with me and decide on the best management strategy for me, including what treatment I require, that the doctor feels at the time, based upon the facts then known, are in the best interest.

I confirm that I have read, or have had read to me, the above consent. I understand that I will have the opportunity to discuss any aspect of this consent with my chiropractor before or during the course of treatment, either in person, telephonically, or via other secure communication. I consent voluntarily to the procedures and treatments described, and acknowledge that my consent may be withdrawn or amended at any time. I further understand that my personal and health information will be processed and stored in compliance with the Protection of Personal Information Act (POPIA) and used only for purposes related to my care and, where applicable, medical aid or legal claims. I acknowledge that by signing this form—whether by handwritten signature on a hard copy or by electronic signature on the online intake form—my consent is valid and binding and carries the same force and effect.

*The parent or legal guardian must sign if the patient is under eighteen (18) years of age.

I, the undersigned, consent to Dr Adriaan Albertus (Aldo) Victor trading as Cape Town Chiropractor (hereinafter referred to as Cape Town Chiropractor) processing my personal information, including health information, or that of my minor child, as the case may be, in order to render the services requested and as may be required in order for Cape Town Chiropractor to carry out its business operations.

I consent and understand that Cape Town Chiropractor will be required to disclose my diagnosis (ICD-10 codes), or the diagnosis of my minor child, as may be applicable, to my medical scheme for purposes of reimbursement and/or settlement of my account, if applicable. I further understand that this disclosure has consequences, and I acknowledge and understand that I will have an opportunity to have the same explained to me.

I acknowledge and understand that once my personal information, or the personal information of my minor child, as the case may be, has been sent to the relevant medical scheme, the medical scheme will be responsible for any further disclosure or utilization of such information for whatever purpose.

I understand and consent to the disclosure of my personal information, and the personal information of my minor child, as may be applicable, to other chiropractors and support staff in the employ of Cape Town Chiropractor only to the extent that it is necessary to carry out the requested services. I acknowledge and understand that each member of staff has signed a confidentiality agreement which ensures that they do not disclose my personal information to any third party, family member etc., unless otherwise required by law.

Cape Town Chiropractor will not disclose any of my health information or that of my minor child, as the case may be, to any friends or family members unless express written consent is given by me authorizing them to disclose certain information to same.

I have the right to withhold my consent to the disclosure of my health information, or the health information of my minor child, as the case may be, by Cape Town Chiropractor, unless required by law. I understand that the same will result in, amongst other things, me having to reimburse and settle my account directly with Cape Town Chiropractor.

I intend for this consent to apply to my present treatment and that of my minor child, if applicable. In future, should it occur that my, or my minor child's, condition changes during the course of treatment, I may be required to sign a new informed consent form in order for Cape Town Chiropractor to provide the services requested.

I further acknowledge and consent that my information (or that of my minor child) may be processed using secure administrative and digital tools to assist in the preparation of clinical and medico-legal documentation (including treatment summaries, progress notes, and reports). At all times, my chiropractor remains the responsible clinician and the sole authorising party for any report or document issued.

I indemnify Cape Town Chiropractor from any liability or damages whatsoever that I, or my minor child, as the case may be, may suffer as a result of the disclosure of my, or my minor child's, personal information and that I will hold this practice and its staff harmless against any disclosures of my, or my minor child's, personal information and prejudice I, or my minor child, as may be applicable, may suffer as a result of such disclosures.

*The parent or legal guardian must sign if the patient is under eighteen (18) years of age.

What is maintenance Chiropractic care and Why Do You Need It?

Maintenance care is a routine practice that helps keep your spine and body healthy, especially if you're often dealing with mental or physical stress. Regular treatments like spinal adjustments and cold therapy can help lower the chances of developing poor posture, back and neck pain, and injuries related to muscles and joints.

People who see a chiropractor every one to three months for spinal adjustments tend to have fewer days with back pain and enjoy longer periods without discomfort. In fact, those who stick to this routine experience less back pain compared to those who only go for help when they're already in pain.

But why should you consider maintenance care even if you’re not experiencing pain?

Getting regular spinal adjustments once a month, even when you feel fine, can help slow down the natural wear and tear on your spine and the muscles around it. It also encourages better flexibility and movement in your spine. If your spine stays stiff or doesn’t move well, it can lead to problems over time, such as muscle weakness and other issues.

Additionally, your muscles may not work as well as they should, even when you're not in pain. This can happen due to a few reasons, including poor posture, muscle overuse, or injuries.

For active individuals, like athletes, it's important to understand that even if you don't feel pain, a misaligned vertebra can weaken the muscles connected to that area. This is because the nerves that control muscles can be affected by spinal issues, leading to weakness in both the spine and the limbs.

In summary, maintaining your spinal health is crucial, not just when you're in pain, but as a proactive measure to keep your body functioning at its best.

Visit www.capetownchiropractor.co.za for more information with scientic support.