TERMS of ACCEPTANCE and INFORMED CONSENT for CHIROPRACTIC CARE

Vertebral Subluxation: A misalignment of one or more of the 24 vertebrae in the spinal column which causes alteration of nerve function and interference to the transmission of mental impulses, resulting in a lessening of the body’s innate ability to express its maximum health potential.

Adjustment: An adjustment is the chiropractic method of removing vertebral subluxation by specific application of forces to the spine.

Health: A state of optimal physical, mental, and social well-being; not merely the absence of pain, disease, or infirmity.

Chiropractic has only one objective, which is to remove vertebral subluxations. I understand the purpose of chiropractic adjustments and that results are not guaranteed.

If, during a chiropractic spinal evaluation, Dr. Kevin Waugh encounters non-chiropractic or unusual findings, he will advise me. If I desire advice, diagnosis, or treatment for those findings, he will recommend that I seek the services of a health care provider who specializes in that area.

I hereby request and consent to the performance of chiropractic adjustments and other chiropractic procedures, including various modes of physical therapy and diagnostic X-rays, on me (or on the patient named below, for whom I am legally responsible) by Kevin Waugh, D.C.

I understand and am informed that there are some risks to treatment, including but not limited to fractures, disc injuries, strokes, dislocations, and sprains. I do not expect Dr. Kevin Waugh to be able to anticipate and explain all risks and complications, and I wish to rely upon him to exercise his judgment during the procedure, which he feels at the time, based upon the facts then known to him, is in my best interest.