Online Forms

To the patient: Please read this entire document prior to signing it. It is important that you understand the information contained in this document. Please ask questions before you sign if there is anything that is unclear.

The nature of the chiropractic adjustment.
The primary treatment we use as a Doctor of Chiropractic is spinal manipulative therapy or adjustments. We will use that procedure to treat you. The procedure may be by hand or with a mechanical instrument placed upon your body in such a way as to move your joints. That may cause an audible “pop” or “click”, much as you have experienced when you “crack” your knuckles. You may feel a sense of movement.

Analysis/Examination/Treatment
In addition to spinal manipulation, we may use a variety of other therapies and examination procedures. As a part of the analysis, examination, and treatment, you are consenting to any and all of the following procedures:

• spinal manipulative therapy/adjustment instrument spinal/extremity adjustment

• vital signs muscle strength testing

• palpation trigger point therapy

• orthopedic testing range of motion testing

• basic neurological exam flexion distraction traction

• postural analysis testing hot/cold therapy

• x-ray/radiographic studies electric muscle stimulation

• rehabilitation/core strengthening nutritional analysis/therapy

• manual traction adjustment laser therapy

• low level laser therapy ultrasound

• spinal segmental traction neuromuscular re-education

• mechanical massage

​​​​​​​The material risks inherent in chiropractic adjustment.
As with any healthcare procedure, there are certain complications which may arise during chiropractic manipulation (CMT) and therapy. However studies have shown that any observed association between vertebral artery dissection (VAD) and stroke with CMT is likely attributed to patients with an undiagnosed VAD who seek care for neck pain and headache before the onset of a stroke. As a result we examine our patients thoroughly before initiating any treatment to be sure that treatment is appropriate. I will make every reasonable effort during the examination to screen for contraindications to care; however, if you have a condition that would otherwise not come to my attention, it is your responsibility to inform me.

​​​​​​​The probability of those risks occurring.

Chiropractic is a safe and comfortable form of health care for most people. If a potential risk is identified, you will be informed and offered either treatment or a referral to the appropriate health care specialist for evaluation and care.

​​​​​​​Soreness: It is not uncommon to experience some localized soreness following a manipulation. This type of soreness is usually minor and occurs most often following the initial few visits. It is similar to the soreness you may experience after exercise.

​​​​​​​Fracture: Fractures caused from spinal manipulation are extremely rare, so rare that an actual number of incidences per manipulation have never been determined. Patients suffering from bone weakening conditions like Osteoporosis are in a higher risk category. Alternative forms of spinal manipulation are utilized for this type of patient.

​​​​​​​TIA/Stroke: Spinal manipulation is clearly one of the safest forms of treatment for cervical spine pain. The incidence of serious adverse events, stroke, or death is very rare. Researchers found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. The risk was as low as 1.46 adverse events per 10,000,000 manipulations. The risk of artery dissection was as low as 1 per 5,846,381 cervical manipulations.

What about NSAIDs and Tylenol? To put it in perspective, non-steroidal anti-inflammatory drugs (NSAIDs) kill approximately 16,500 people per year annually in the US. And Tylenol toxicity is now the leading cause of liver failure in the US. Spinal manipulation is safer than NSAIDs by a factor of several hundred times.


​​​​​​​Note: Screening tests are performed when necessary to rule out high-risk patients. Alternative spinal adjusting is utilized when necessary to minimize potential risks.

​​​​​​​Ruptured/Herniated Disc: include but are not limited to: fractures, disc injuries, dislocations, muscle strain, cervical myelopathy, costovertebral strains and separations, and burns.

​​​​​​​Other complications: There have been some reports of herniated or ruptured discs caused by spinal manipulation. Alternative spinal adjusting methods are often utilized to minimize the risk and help the patient recover from serious disc-related pain.

​​​​​​​The availability and nature of other treatment options:

Other treatment options for your condition may include:
- Self-administered, over-the-counter may include:
- Medical care and prescription drugs such as anti-inflammatory, muscle relaxants and pain-killers
- Hospitalization
- Surgery