We would like to take this opportunity to welcome you to Ace Sports Clinic.
Our Osteopathic Manual Practitioners utilize a gentle hands-on manual therapy approach, and follow the principles of Osteopathy which aim to restore the body’s function by treating the underlying causes of pain and imbalance.
Osteopathic Manual Practitioners who use manual therapy techniques such as spinal manipulations (adjustments) are required to advise patients that there are possible risks associated with such treatment.
In particular, you should note:
(a) While rare, some patients have experienced rib fractures or muscle strains and ligament sprains following manual therapy procedures.
(b) There have been reported cases of injury to a vertebral artery following cervical spinal adjustments. Vertebral artery injuries have been known to cause stroke with serious neurological impairment or even death. The possibility of such injuries resulting from cervical spinal adjustment is extremely remote. Your practitioner will ask multiple questions to determine the likelihood of an adverse reaction occurring. If any risk factors are found, manipulation will be avoided. It is your choice to continue or discontinue each treatment technique. Just let your practitioner know if you are unwilling to proceed. You must inform your Osteopathic Manual Practitioner if you are suffering from any of the following symptoms which may increase the risks associated with cervical spine manipulation, especially if associated with movements of the head and neck: dizziness, vertigo or fainting, disturbance of vision (i.e blurred or double vision), nausea or vomiting, difficulty speaking or swallowing, or loss of facial sensation.
(c) There are rare reported cases of disc injuries following cervical and lumbar spinal adjustment, although no scientific study has ever demonstrated such injuries are caused, or may have been caused, by spinal adjustments or osteopathic treatment.
(d) There are infrequent reported cases of burns or skin irritation in association with the use of some types of electrical therapy offered by some osteopathic practitioners.
Female Patients: Please inform your Osteopathic Manual Practitioner if you are pregnant.
I acknowledge I have read this consent and I have had the opportunity to discuss, with my Osteopathic Manual Practitioner, the nature and purpose of Osteopathic treatment in general and my treatment in particular (including spinal adjustments) as well as the contents of this Consent.
I consent to Osteopathic treatment which may consist of manual therapy (including spinal adjustments), electrical modalities, muscle energy techniques, hot/cold therapy, exercises, education and advice on health enhancing behaviours. I intend this consent to apply to all my present and future Osteopathic treatments at Ace Sports Clinic. I have the right to withdraw consent to any part of the treatment at any time and will notify my Osteopathic Manual Practitioner of any changes in my health immediately.