Consent to Chiropractic Care at Belmont Chiropractic

Chiropractic care is recognised as being an effective and safe method of care for many conditions. However, you must recognise that there are risks associated with all health care procedures, including assessment and treatment, which you should be informed about.

Please read the following carefully:


  1. I acknowledge that I have discussed with chiropractor the rare risks associated with my proposed care which include but are not limited to muscle and joint soreness or strains (temporary soreness occurs in about 1:3 people), headache, nausea and dizziness, and an exacerbation and/or aggravation of my underlying condition. Such risks will be screened in your health history, but may result in outcomes such as referral, further tests, surgery.
  2. 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: less than 1 in 139,000) and the low back (current statistics: 1 in 62,000 Dvorak study, Haldeman 2nd Ed.). For some patients especially with bone weakening diseases, a fracture of a bone although rare is possible.
  3. I understand the Chiropractor will take all precautions to minimise risk and modify their methods according to age, individual body type and client requests.
  4. I have had the opportunity to discuss the proposed care with my chiropractor. I also acknowledge that I have had the opportunity to ask questions about the nature, extent and purpose of the proposed chiropractic care and that I have been given sufficient time to make a decision giving consent for the care to proceed.
  5. I acknowledge that I am aware of and understand the potential risks. I appreciate that results are not guaranteed.
  6. I do not expect the practitioner to be able to anticipate all potential risks and complications associated with the proposed care.
  7. I hereby acknowledge my consent to the performance of the proposed chiropractic care and/or any other chiropractor working in this clinic. I understand that I can withdraw consent at any time.
  8. The alternatives to the treatment are no treatment, medicine provided by a general practitioner, physiotherapy, surgery.

What's next?

If you haven’t already submitted your new patient intake form then head back to the email we sent you and follow the link to complete your patient form. It’s a small but important step to making your first appointment super smooth and easy.