Informed Consent Document
To the patient: Please read this entire document prior to signing it. It is important that you understand the information contained in this document. Please ask questions before you sign if there is anything that is unclear.
The nature of the chiropractic adjustment:
The primary treatment used in our office is spinal manipulative therapy. The doctor will use that procedure to treat you. The doctor may use their hands or a mechanical instrument upon your body in such a way as to move your joints. That may cause an audible "pop" or "click," much as you may have experienced when you "crack" your knuckles. You may also feel a sense of movement.
As part of the analysis, examination, and treatment, you are consenting to the following procedures: spinal manipulative therapy, range of motion testing, muscle strength testing, ultrasound/cold laser, palpation, orthopedic testing, posture analysis, hot/cold therapy, vital signs, basic neurological testing, electric muscle stimulation.
The material risks inherent in chiropractic adjustment:
As with any healthcare procedure, there are certain complications, which may arise during chiropractic manipulation and therapy. These complications include but are not limited to: fractures, disc injuries, dislocations, muscle strain, cervical myelopathy, costovertebral strains and separations, and burns. Some types of manipulation of the neck have been associated with injuries to the arteries in the neck leading to or contributing to soreness following the first few days of treatment. The doctor will make every reasonable effort during the examination to screen for contraindications to care, however, if you have a condition that would otherwise not come to my attention, it is your responsibility to inform the doctor.
The probability of those risks occurring:
Fractures are rare occurrences and generally result from some underlying weakness of the bone, which the doctor will check for during the taking of your history and during examination and x-ray. Stroke has been the subject of tremendous disagreement. The incidences of stroke are exceedingly rare and are estimated to occur between one in one million and one in five million cervical adjustments. The other complications are also generally described as rare.
The availability and nature of other treatment options:
Other treatment options for your condition may include: self-administered, over-the-counter analgesics and rest, medical care and prescription drugs such as anti-inflammatory medications, muscle relaxants, and pain killers, hospitalization, and/or surgery.
If you choose to use one of the above noted "other treatment" options, you should be aware that there are risks and benefits of such options and you may wish to discuss these with your primary medical physician.
The risk and dangers attendant to remaining untreated:
Remaining untreated may allow the formation of adhesions and reduce mobility, which may set up a pain reaction further reducing mobility. Over time, this process may complicate treatment making it more difficult and less effective the longer it is postponed.
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