CHIROPRACTIC INFORMED CONSENT TO TREAT
Download a printable copy of our Complete Informed Packet by completing the form located on this page.
I hereby request and consent to the performance of chiropractic procedures, including various modes of physio therapy, diagnostic x-rays, and any supportive therapies on me (or on the patient named below, for whom I am legally responsible) by the doctor of chiropractic indicated below and/or other licensed doctors of chiropractic and support staff who now or in the future treat me while employed by, working or associated with or serving as back-up for the doctor of chiropractic named below, including those working at the clinic or office listed below or any other office or clinic, whether signatories to this form or not.
I have had an opportunity to discuss with the doctor of chiropractic named below and/or with other office or clinic personnel the nature and purpose of chiropractic adjustments and procedures.
I understand and I am informed that, as is with all Healthcare treatments, results are not guaranteed and there is no promise to cure….
To get the rest of the Informed consent and download a printable copy complete the form located on this page.