Informed Consent
Please read the document in its entirety prior to signing. It is important that you understand the information contained in this document. Please ask questions before you sign if there is anything that is unclear.
A patient, in coming to Bensa Chiropractic and Wellness, LLC, gives the doctors permission and authority to care for the patient in accordance with the chiropractic exam, analysis, diagnosis, and treatment of the joints and soft tissues.
As with any healthcare procedure, there are certain complications which may arise during the chiropractic adjustment and other clinical procedures. The chiropractic manipulation and other therapy are usually beneficial and seldom cause any problems. In rare cases, possible complications include but are not limited to: fractures, disc injuries, dislocations, muscle strain, cervical myelopathy, costovertebral strains and separations, and physical therapy burns. Some types of manipulation of the neck have been associated with injuries to the arteries in the neck leading to or contributing to serious complications, including stroke. Some patients will feel some stiffness and soreness following the first few days of treatment. We will make every reasonable effort during the examination to screen for contraindications to care; however, it is the responsibility of the patient to make it known, or to learn through health care procedures whatever he or she is suffering from: latent pathological defects, illnesses or deformities which would otherwise not come to the attention of the doctors.
Fractures are rare occurrences and generally result from some underlying weakness of the bone which is screened for during the consultation, examination, and x-ray. The incidences of stroke are exceedingly rare and are estimated to occur between once in one million and once in ten million cervical adjustments.
Other treatment options for your condition may include:
• Self-administered, over the counter analgesics and rest
• Medical care and prescription drugs such as anti-inflammatory, muscle relaxants, and pain killers
• Hospitalization
• Surgery
Remaining untreated may allow the formation of adhesions and arthritis and reduce mobility which may set up a pain reaction further reducing mobility. Over time this process may complicate treatment making it more difficult and less effective the longer it is postponed.
I have read or have had read to me the above informed consent and I understand that if I am accepted as a patient by the doctors at Bensa Chiropractic and Wellness, LLC, I am authorizing them to proceed with any treatment that may be necessary. Any questions I have had regarding these procedures have been answered to my satisfaction prior to my signing the consent form. I have made my decision voluntarily and freely.