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INFORMED CONSENT |
| CHIROPRACTIC It is important to acknowledge the difference between the health care specialties of chiropractic, osteopathy and medicine. Chiropractic health care seeks to improve health through natural means without the use of drugs or surgery. This gives the body maximum opportunity to utilize its inherent healing ability. The success of the doctor of chiropractic's procedure often depends on underlying causes, physical and spinal conditions. It is important to understand what to expect from your chiropractic health care. ADJUSTMENTS Dr. Kirk Eriksen utilizes the Grostic Procedure, which is a low force, non-rotary upper cervical (neck) technique. If adjustments to the lower spine are required, then the doctors will usually utilize a low force, non-rotary drop table, activator or flexion-distraction technique. If another type of procedure is required, then you will be informed and it will be noted in your records. INFORMED CONSENT FOR CHIROPRACTIC CARE As a patient, you give the above doctor(s) permission and authority to care for you in accordance with the chiropractic tests and analysis. The chiropractic adjustment or other clinical procedures are usually beneficial and seldom cause any problem. In rare cases, underlying physical defects or pathologies may render a patient susceptible to injury. The doctor will not provide health care, if he is aware that such care may be contraindicated. Again, it is your responsibility to tell the doctor everything you know about your health conditions which would otherwise not come to the attention of the doctor of chiropractic. The doctor of chiropractic provides a specialized, non-duplicating health service, but he is also available to work with other types of health care providers. RESULTS As a patient in this office, you are acknowledging that your doctor or his assistants have given no guarantee, as to the results that may be obtained from your care. The doctors also want it understood that although they do not utilize rotary manipulation, they are in no way indicating that their lower force procedures are superior to their fellow chiropractors. Please understand that chiropractic care is not a treatment of disease, but a system of correcting vertebral subluxations. AUTHORIZATION In certain cases, it may be necessary for the doctor to discuss or send reports to other doctors, attorneys and/or insurance representatives for gaining a second opinion or reimbursement from insurance carriers. As a patient, you are giving the doctor permission to use his best judgment for when to allow an observer in the room or when it is necessary to release the above patient information. I also give permission for the Doctor to use information from my examination to help evaluate statistics for research, as long as my name is not used. TO THE PATIENT Please discuss any questions or problems with the doctor before signing this statement of policy. I have had the above explained to me and after reading it, I understand the foregoing and give my consent. DATE ______________ SIGNATURE ____________________________________________ |