Informed Consent and Disclaimer
The nature of Chiropractic care: You hereby request and consent to the performance of Chiropractic adjustments and other Chiropractic procedures, including various modes of physical therapy, Diagnostic X-rays, and any supportive therapies on me ( or the patient, for whom I am legally responsible) by Dr. Youdeem and/or other licensed Doctors of Chiropractic and support staff who now or in the future treat me while employed by, working or associated with or serving as back-up for Dr. Youdeem, including those working at this clinic or office or any other office or clinic, whether signatories to this form or not. I understand I will have to an opportunity to discuss my case with Dr. Youdeem and/or with other office or clinic personnel the nature and purpose of the Chiropractic adjustments and procedures.
The risks inherent with Chiropractic care and the probability of those risks: I understand and am informed that, as in the practice of medicine and like all other health modalities, results are not guaranteed, and there is no promise of cure. I further understand and am informed that, as in the practice of medicine, in the practice of chiropractic the are some risks to treatment, including, but not limited to, fractures, dis injuries, strokes, dislocations and sprains. I do not expect the doctor to be able to anticipate and explain all risks and complications, and I wish to rely on the doctor to exercise judgment during the course of the procedure which the doctor feels at the time, based upon the facts then known, is in my best interests.
The nature of the spinal decompression: You will be harnessed in with 2 separate harnesses and your spine will be gently lengthened in order to decompress herniated or bulging discs or re-hydrate degenerated discs.
The material risks inherent with spinal decompression: As with any healthcare procedure, there are certain complications that may arise during spinal decompression. This may include: strains, muscle spasms, disc injuries and worsening of your pain. This list is not all inclusive.
The probability of those risks: The complications listed are considered rare. The most common risk is a dull, achy soreness similar to having just worked out for the first time in a long time. This is usually due to stretching of tight muscles that haven’t been stretched in this way. This will typically go away within the first week or two of treatments. We will warm the tissues up before treatment and will decompress your spine more conservative at first to prevent as much soreness as we can. It is recommended that you ice for 20 minutes up to 3 times daily for the first week to decrease pain and soreness.
Ancillary treatments recommended: Ice, Moist Heat Packs, Cold Laser Therapy Stretching/Strengthening Exercises, Massage Therapy, Electrical muscle stimulation.
Risks involved with the recommended ancillary treatments: Ice, Heat and Electrical Muscle Simulations (EMS) can cause burning. The EMS can cause skin irritation underneath the active pads. Stretching/Strengthening Exercises and Decompression Spinal Traction can cause temporary post-treatment soreness or reflex muscle spasms. This list is not all inclusive.
Other treatment options for your condition can include: Medical care with prescription drugs, self management with over-the-counter medication, rest, and/or surgery. There are material risks inherent in each of these options including but not limited to: addiction to medication, side effects of medication, improper self dosages and surgical risks including complications from either the procedure or the anesthesia. I understand and now informed that I have the right to a second opinion and to secure other opinions if I have concerns as to the nature of my symptoms and treatment options.
Signature requirement: I understand this online informed consent has been provided in order that I will have an opportunity to read and consider any questions prior to my visit because I will be afforded an opportunity to ask questions about its content. I will be required to sign an informed consent form in Dr. Youdeem's office which will cover the entire course of treatment for nay present condition and for any further condition(s) for which I seek treatment.