Free Chiropractic Clinic Treatment Consent Form Template

Chiropractic Clinic Treatment Consent Form

Please read the information carefully and sign at the bottom.

Patient Name

    Date Of Birth

      Phone Number

        Consent for Treatment

        1. I have had the opportunity to discuss my condition and treatment options with the chiropractor.

        2. I have been informed about the nature, purpose, risks, and benefits of the proposed treatments.

        3. I consent to receive chiropractic care and understand that I may withdraw my consent at any time.

        I authorize the clinic to perform chiropractic evaluations and treatments as deemed necessary. I also consent to any additional diagnostic or therapeutic procedures recommended during the course of care.

        Name:

        Date:

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