Consent Form

    NATURE OF CHIROPRACTIC TREATMENT

    Prior to beginning treatment, you will be given a physical examination that can include taking vital signs, range of motion testing, muscle strength testing, palpation, orthopedic testing, neurological testing and X-rays. Once your condition has been diagnosed, the primary method of treatment will be spinal manipulation, also known as spinal adjustment. An adjustment is a quick, precise movement of the spine over a short distance. Adjustments are usually performed by hand but may be performed by hand-guided mechanical instruments. In addition to spinal manipulation, treatment can also involve other forms of therapy including ultrasound, electrical stimulation, traction, hot and cold packs, exercise and nutritional supplements.

    RISKS OF CHIROPRACTIC TREATMENT

    All health care procedures carry some degree of risk. The most common side effect of spinal manipulation is short-term muscle soreness. More serious side effects can include bone fractures, muscle strain, ligament sprain, joint dislocation and injury to the discs, nerves or spinal cord. Some manipulations of the upper spine have been associated with injury to the arteries in the neck, which could cause or contribute to stroke.

    As for chiropractic therapies other than spinal manipulation, the risks are also very slight but can include skin irritation or burns. Compared to other forms of health care, chiropractic is extremely safe, and complications are generally rare.

    TREATMENT OPTIONS OTHER THAN CHIROPRACTIC

    Other treatment options for your condition may include:
    - Self-administered, over-the-counter analgesics
    - Medical care and prescription drugs such as muscle relaxers, pain killers and drugs to reduce inflammation
    - Surgery
    - Remaining untreated
    If you decide to pursue other treatment options, you should discuss the risks and benefits with your medical physician. Remaining untreated carries its own risks and may allow the formation of adhesions, scar tissue and other degenerative changes. These changes can further reduce mobility and induce chronic pain cycles.

    UNUSUAL RISK

    If your pre-treatment examination reveals any health issues that would make some forms of chiropractic treatment inadvisable (contra-indicated), your chiropractor will explain the risks to you and answer any questions you may have.

    I have read and understand the above explanation of chiropractic treatment and give Carlisle Chiropractic Clinic permission to treat me YesNo

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