Consent Form
When performed by a qualified Chiropractor, spinal adjustment is an effective and safe method of treatment for many painful and other conditions. There are however, risks associated with any treatment and we are required to inform you of these regardless of how small the risk may be. Please read the following. If you have any questions please ask your Chiropractor.
I hereby request and consent to the performance of Chiropractic treatment on me by any registered Chiropractor authorised by the principle of Complete City Health.
I understand that the results are not guaranteed.
I understand and am informed that, as in the practice of medicine, in the practice of Chiropractic there are some very slight risks to treatment, including but not limited to: muscle and joint soreness, muscle strains, joint sprains, fractures, disc injuries, nerve injuries, stroke and stroke-like episodes.
I do not expect the Chiropractor to be able to anticipate and explain all risks and complications.
I wish to rely on the Chiropractor to exercise judgment during the course of treatment which the Chiropractor feels, based on the facts known at that time, is in my best interests.
The proposed Diagnostic imaging procedure has been explained to me in full and I have had the opportunity to ask questions.
I have read the above, and have also had the opportunity to ask questions about its content.
I intend this consent form to cover the entire course of treatment for my present condition, and for any other future condition(s) for which I seek treatment.
I understand that I can withdraw consent at any time.