This is to confirm that since coming to CBD Health Plus (Chiropractic) – I have completed the entrance questionnaire and am aware that the management used in this centre is specific manipulations, called adjustments.
When performed by a qualified chiropractor, spinal manipulation is an effective and safe method of treatment for many conditions. There is however risks associated with any treatment and I am required to inform you of these even though there has never been a case at this centre. Please read the following carefully and direct any questions you may have to attending chiropractor.
I hereby request and consent to the performance of chiropractic treatment on my self by Dr Louise Mackenzie of Chiropractic BSc, BSc (Chiro) and /or any other chiropractor working in this centre authorized by L Mackenzie.
I have had the opportunity to discuss with L. Mackenzie and/or associate chiropractor the nature and the purpose of chiropractic treatment.
I understand, and I am informed that, as in the practice of medicine, in the practice of chiropractic there are some very slight risks to treatment, including but not limited to, muscle and joint soreness, muscle strains, joint sprains, fractures, disk injuries, strokes and stroke like episodes.
I do not expect the chiropractor to be able to anticipate and explain all-risks and complications and wish to rely on the facts then known is in my best interests. I have read the above and I have had the opportunity to ask questions about its content. I intend this consent form to cover the entire course of treatment for my present condition and for any other future conditions (S) for which I seek treatment.
I understand I can withdraw my consent at any time.
Dated: November 26, 2020