Informed consent
Chiropractic and manual therapy care is recognised as being an effective and safe method of care for many conditions. However, you must recognize that there are risks associated with all health care procedures, including assessment and treatment, which you should be informed about. I acknowledge that I have discussed the rare risks associated with my proposed care which include but are not limited to muscle and joint soreness or strains, nausea and dizziness, fractures, disc injuries including disc encroachments/ruptures, causing nerve irritation and referred symptoms, strokes (or like episodes) and an exacerbation and/or aggravation of my underlying condition.
I also acknowledge the following additional potential risks insofar as my proposed care is concerned have been explained to me
Where the use of dry needling or cupping therapy is performed bruising and tenderness can occur. Rare risks associated with dry needling include pneumothorax, infection, nerve injury and organ perforation. In very rare circumstances, some treatments of the neck may damage a blood vessel and lead to stroke or related symptoms (current statistics eg between 1 in 2 million to 1 in 5.85 million -Haldeman, et al. Spine vol 24-8 1999). Other possible risks include strain/injury to a ligament or a disc in the neck (current statistics eg less than 1 in 139,000) and the low back (current statistics eg 1 in 62,000 Dvorak study in Principles & Practice of Chiropractic, Haldeman 2nd Ed.). For some patients especially with bone weakening diseases, a fracture of a bone although rare is possible.”
I have been advised that appropriate management may include the following;
Chiropractic manipulation or mobilisation of the spine and extremities, soft tissue therapy (Massage, dry needling, Cupping therapy, stretching), taping, rehabilitation exercises, hot and cold therapy, electrotherapy like electro-dry needling, and healthy lifestyle
Please read and check on the online form
- I have had the opportunity to discuss the proposed care with the chiropractor and also acknowledge that I have had the opportunity to ask questions about the nature, extent and purpose of the proposed chiropractic care.
- I acknowledge that I am aware of and understand the potential risks. I understand that results are not guaranteed.
- I have been given sufficient time to consider the proposed care and would like to continue with the proposed care. I have been given alternatives to treatment.
- I understand that I can withdraw consent at any time.
I hereby acknowledge my consent to the performance of the proposed chiropractic care by
Dr Joel McGuffie, Dr Jason Colvin, Dr Lia Armstrong, Dr Garret Kow, Dr Sara Craggs, Dr Liza Joubert or any other chiropractor at this clinic.