Free Chiropractic Clinic Consent Form Template
Chiropractic Clinic Consent Form
Please read carefully before signing this form.
Name
Date Of Birth
Home Address
Phone Number
Email Address
I, the undersigned, understand and agree to the following:
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Nature of Chiropractic Care: Chiropractic treatment involves spinal adjustments and other therapeutic procedures to address musculoskeletal conditions. These may include manual adjustments, soft tissue therapy, therapeutic exercises, and other non-invasive techniques.
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Potential Risks: While chiropractic care is generally safe, I acknowledge that there are potential risks, including but not limited to:
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Temporary soreness or stiffness
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Minor bruising
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Rare complications such as nerve irritation, disc injury, or stroke
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Alternative Treatments: I am aware that alternative treatment options include medication, physical therapy, or surgical interventions. I understand I am free to seek these options at any time.
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Right to Discontinue Care: I have the right to discontinue treatment at any time and will inform the clinic if I choose to do so.
By signing below, I acknowledge that I have read and understood this consent form, and I agree to the terms outlined.
Name:
Date:
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