Informed Consent


You are the decision maker for your healthcare. Part of our role is to provide you with information to assist you in making informed choices. This process is often referred to as “informed consent” and involves your understanding and agreement regarding the care we recommend, the benefits and risks associated with the care, alternatives, and the potential effect on your health if you choose not to receive the care.

We may conduct some diagnostic or examination procedures if indicated. Any examinations or tests conducted will be carefully performed but may be uncomfortable.

Chiropractic care centrally involves what is known as a chiropractic adjustment. There may be additional supportive procedures or recommendations as well. When providing an adjustment, we use our hands or an instrument to reposition anatomical structures, such as vertebrae. Potential benefits of an adjustment include restoring normal joint motion, reducing swelling and inflammation in a joint, and improving neurological functioning and overall well-being.

It is important that you understand, as with all healthcare approaches, results are not guaranteed, and there is no promise to cure. As with all types of healthcare interventions, there are some risks to care, including, but not limited to: muscle spasms, aggravating and/or temporary increase in symptoms, lack of improvement of symptoms. With respect to strokes, there is a rare condition known as cervical arterial dissection that involves an abnormal change in the wall of an artery that may cause the development of a thrombus (clot) with the potential to lead to stoke. This occurs in 3-4 of every 100,000 people whether they are receiving health treatments or not. The association with stroke is exceedingly rare and is estimated to be related in one in one million to one in two million cervical adjustments.

It is also important that you understand there are treatment options available for your condition other than chiropractic procedures. Likely, you have tried many of these approaches already. These options may include, but are not limited to self-administered care, over-the-counter pain relievers, physical measures and rest, medical care with prescription drugs, physical therapy, bracing, injections, and surgery. Lastly, you have the right to a second opinion and to secure other opinions about your circumstances and healthcare as you see fit.

I have read, or have had read to me, the above consent. I appreciate that it is not possible to consider every possible implication of care. I have also had an opportunity to ask questions about its content, and by signing below, I agree with the current, or future recommendation to receive chiropractic care as is deemed appropriate for my circumstance. I intend this consent to cover the entire course of care from all providers in the office for my present condition and for any future condition(s) for which I see chiropractic care from this office.


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Signature Certificate
Document name: Informed Consent
lock iconUnique Document ID: 2349279e38f2d2335dc6e684f53a9abf45dd4e60
Timestamp Audit
September 1, 2020 10:16 am MSTInformed Consent Uploaded by Anthony Janssen - IP