The chiropractic care provided at this visit may or may not include an adjustment, musculoskeletal soft tissue treatment, physiotherapy, neurological rehabilitation, nutrition advice & or strength & conditioning coaching. An adjustment is the application of a quick precise movement to a specific segmental contact point on the musculoskeletal system with skilled hands. You should understand that the exam, analysis & care are not provided by a medical or osteopathic doctor but by a Doctor of Chiropractic. You should understand that all healthcare procedures including chiropractic adjustments have associated risks. Theses may include sprain/ strain, neurological deficits, osseous fracture & stroke.
I have read the above paragraph & understand the nature & purpose of the chiropractic care provided the possible consequences, & involved risk. I understand that the care may not accomplish the desired objective & acknowledge that no guarantees have been made concerning the results of the care and/or treatment. By typing my signature below, I authorize Dr Amanda Smith to proceed with chiropractic care and/or treatment.
Cancellations & changes to appointment times made within 24 hours of the agreed time will be subject to 100% cost of the visit. Please communicate so this will not be an issue
Type Signature below.