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Chiropractic care has a very low-risk profile, especially when compared with more invasive methods of spinal healthcare however, all forms of chiropractic treatment have the potential for adverse reactions in some people.
1. I acknowledge the rare risks associated with my care which include but are not limited to muscle and joint soreness or strains, nausea and dizziness, fractures, disc injuries including disc encroachments/ruptures, causing nerve irritation and referred symptoms, strokes (or like episodes) and an exacerbation and/or aggravation of my underlying condition. Such risks may result in outcomes such as referral, further tests, surgery, incapacity, and the like.
2. I will have the opportunity to discuss my proposed care with my practitioner.
3. I also acknowledge that I will have the opportunity to ask questions about the nature, extent, and purpose of the proposed care and that I have been given sufficient time to make a decision giving consent for the care to proceed.
4. I acknowledge that I am aware of and understand the potential risks. I appreciate that results are not guaranteed.
5. I do not expect the practitioner to be able to anticipate all potential risks and complications associated with the proposed care. I hereby acknowledge my consent to the performance of the proposed care at Chiro & Sports Med and/or any practitioner working in this clinic.
6. In very rare circumstances, some treatments of the neck may damage a blood vessel and lead to stroke or related symptoms (current statistics eg between 1 in 2 million to 1 in 5.85 million Haldeman, et al. Spine vol 24-8 1999). Other possible risks include strain/injury to a ligament or a disc in the neck (current statistics eg less than 1 in 139,000) and the low back (current statistics eg 1 in 62,000 Dvorak study in Principles & Practice of Chiropractic, Haldeman 2nd Ed.). For some patients especially with bone weakening diseases, a fracture of a bone although rare is possible.”
7. I understand that I can discuss any concern with my treating practitioner at any and all consultations I may have, and I can withdraw consent at any time.