Free Chiropractic Clinic Consent Form

Please read carefully before signing this form.
Name
Date Of Birth
Home Address
Phone Number
Email Address
I, the undersigned, understand and agree to the following:
Nature of Chiropractic Care: Chiropractic treatment involves spinal adjustments and other therapeutic procedures to address musculoskeletal conditions. These may include manual adjustments, soft tissue therapy, therapeutic exercises, and other non-invasive techniques.
Potential Risks: While chiropractic care is generally safe, I acknowledge that there are potential risks, including but not limited to:
Temporary soreness or stiffness
Minor bruising
Rare complications such as nerve irritation, disc injury, or stroke
Alternative Treatments: I am aware that alternative treatment options include medication, physical therapy, or surgical interventions. I understand I am free to seek these options at any time.
Right to Discontinue Care: I have the right to discontinue treatment at any time and will inform the clinic if I choose to do so.
By signing below, I acknowledge that I have read and understood this consent form, and I agree to the terms outlined.
Name:
Date:
Thank you for your submission!
We appreciate you taking the time to submit.
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Ensure informed consent with the Chiropractic Clinic Consent Form Template on Template.net. This editable and customizable template outlines procedures, risks, and permissions required before treatment. Personalize it with the Ai Editor Tool to align with legal and ethical standards, fostering trust and transparency with patients. Download our template now!