Free Chiropractic Clinic Consent Form

Please read carefully before signing this form.

I, the undersigned, understand and agree to the following:

1. 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.

2. 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

3. 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.

4. 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:

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