Health care providers are required to advise patients of the nature of the treatment to be provided, the risks and benefits of the treatment, and any alternatives to the treatment.
Risks Associated with Treatment
a. While rare, some patients have experienced rib fractures or muscle and ligament sprains or strains.
b. There have been rare reported cases of disc injuries following cervical and lumbar spinal adjustment, although no scientific study has demonstrated such injuries are caused by manipulation.
c. There have been reported cases of injury to a vertebral artery following osseous spinal manipulation. Vertebral artery injuries have been known to cause a stroke. The possibility of such injuries from cervical spine manipulation is extremely remote.
Osseous and soft tissue manipulation has been demonstrated to be a highly effective treatment for spinal conditions, including general pain and loss of mobility, headaches, and related symptoms. The risk of complications from treatment is substantially lower than many medical treatments given for the same symptoms.
Patient Acknowledgment
I acknowledge that I have discussed with my health care provider: (a) the condition to be addressed; (b) the nature of the treatment; (c) the risks and benefits; and (d) alternatives to treatment. I have had the opportunity to ask questions and receive answers.
Consent
I consent to the treatments offered or recommended to me by my health care provider, including osseous and soft tissue manipulation. I intend this consent to apply to all my present and future care with Dr. Caroline Kirkpatrick, D.C. and all associates.
Your typed name below serves as your electronic signature.