1001-G East W.T. Harris Blvd
Charlotte, NC 28213
THE NATURE AND PURPOSE OF CHIROPRACTIC
Adjustments are made by chiropractors in order to correct spinal extremity joint subluxations.
One of the most common disturbances to the nervous system is the vertebral subluxation. This
condition is one where one or more vertebra in the spine is misaligned sufficiently to cause
interference and/or irritation to the nervous system. The primary goal in Chiropractic health
care is the removal of nerve interference caused by subluxation.
The chiropractic adjustment is the application of precise, high velocity movement of the spine
over a very short distance. There are a number of different methods or techniques by which the
chiropractic adjustment is delivered. Chiropractic adjustments are typically delivered by hand,
but some may require the use of an instrument or other specialized equipment. In addition,
physiotherapy or rehabilitative procedures may be included in the management protocol.
I have been informed of the nature and purpose of chiropractic care, the possible consequences
of care, and the risk of care, including the risk that the care may not accomplish the desired
objective. Reasonable alternative treatments have been explained, including the risks,
consequences and probably effectiveness of each. I have been advised of the possible
consequences if no care is received. I acknowledge that no guarantees have been made to me
concerning the result of the care and treatment.
I HAVE READ THE ABOVE PARAGRAPH. I UNDERSTAND THE INFORMATION PROVIDED.
ALL QUESTIONS I HAVE ABOUT THIS INFORMATION HAVE BEEN ANSWERED TO MY
HAVING THIS KNOWLEDGE, KNOWINGLY AUTHORIZE ACCIDENT RECOVERY CENTER
TO PROCEED WITH CHIROPRACTIC CARE AND TREATMENT.