Doctor Sterling Adjustment Consent

To the patient (or their parent, legal guardian, court appointed conservator, or agent): Please read this entire form prior to signing it. It is important that you understand the information contained in this form. Please ask any questions prior to signing this form if you are unclear about anything in this form.

Chiropractic Adjustments

The primary treatment rendered by the Doctor of Chiropractic to you will be chiropractic adjustments, which are purposefully intentioned movement of bones with the desired effect being to remove interference to nerves, which then allows your body to use its innate ability to heal itself. Chiropractic adjustments also have the desirable effect of enabling muscles, tendons, and ligaments to properly function and heal, and also allows blood flow to properly occur. Chiropractic adjustments can be made by either the use of hands or mechanical instruments to any bone or joint in the body including both spinal and extremity bones. You may or may not hear an audible sound. which is just air being released from the joint space as bones are moved into their proper positions.

Examination

Dr. Sterling will do a thorough examination as some conditions may be more easily missed without the proper examination and proper equipment. If there are any contraindications to getting adjusted, or if you have some undisclosed prior history of any spinal or musculoskeletal condition you must tell Dr. Sterling prior to the adjustment. Dr. Sterling is only licensed in California and Florida and if any adjustments are happening outside of those states you accept that there is nothing legally binding between you and and Dr. Sterling.

Potential Benefits of Chiropractic and Associated Care

The vast majority of chiropractic patients tend to achieve good to excellent improvement in their physical conditions with chiropractic care. Improvement can be measured in many different ways, including reduction in pain, increased range of motion, less stiffness, increased athletic performance, and in other ways. It must be remembered that different people get different results, different people have different pre-existing conditions, and are of different ages and occupations (with different types of physical stress). Your situation is unique, and no guarantees are given. You will have to determine what results you get for yourself and report them to your Doctor of Chiropractic.

Material Risks Inherent with Chiropractic Adjustments and Other Treatment

As with any healthcare procedure, there are certain complications which may arise when chiropractic adjustments and other care/procedures are performed. These complications include but are not limited to fracture of bones, disc injuries , dislocations, muscle strains, cervical myelopathy, strokes, radiation exposure, costovertebral strains and separations and burns. Some individuals feel some stiffness and /or soreness following the first few days of treatment. The Doctor of Chiropractic will make every reasonable effort during the examination to screen for contraindications to care, but remember it is your responsibility to inform the Doctor of Chiropractic of any conditions that would not otherwise come to their attention.

Probability of Risk Occurring

Fractures are rare occurrences and generally result from some underlying weakness of bone. Even though a competent history, examination (which may include radiography) will be performed, it is still possible for some weakness of bone to be undetected. Extremely rare are strokes from vertebral artery dissection which also occur in about one person in 133,000 in general (not related to chiropractic), but are estimated to occur in between one in one million and one in five million cervical adjustments . Although discs are generally helped with chiropractic care, they can be worsened even to the point of requiring surgical care (although this rarely occurs).

A perspective on the risks of chiropractic care as compared to medical care can be seen by the money paid by different doctors for a $1,000,000 malpractice liability policy. The following annual premiums listed are close approximations, although not exact. A general medical doctor pays about $20,000 per year, an internal medicine gynecologist (OBGYN) pays about $150,000 per year for a $1,000,000 malpractice liability policy. In stark contrast to medical doctors whose patients encounter significantly more risk than those of Doctors of Chiropractic, Doctors of Chiropractic in California pay about $3000 per year. Also, it has been reported that about 187,000 deaths occur every year from medical malpractice, but that the number for chiropractic is typically zero per year.

Consequences of Not Obtaining Chiropractic Care

Not obtaining chiropractic care will have the effect of not obtaining its benefits such as having your body function at its best ability, reducing pain, peak athletic performance, etc. Not obtaining chiropractic care may allow formation of adhesions and reduce mobility which may set up a pain reaction further reducing mobility.

Over time this process may complicate treatment making it more difficult, requiring more time (and money), and being less effective when chiropractic care is obtained later in time. Not obtaining chiropractic care following trauma such as whiplash or other effects of automobile accidents will cause injured muscles, tendons, and ligaments to heal improperly and be significantly weaker and more prone to re-injury as compared to receiving proper chiropractic care following such accidents/injuries.

Consent of use for Social Media 

By signing this form you are agreeing to allow Dr. Sterling to use any video or pictures recorded of the chiropractic adjustment or care for any of his social media accounts. You are allowing Dr. Sterling to use any of the content recorded for any public future use including social media posts, ads and promotions. I release and discharge Dr. Sterling and any associated businesses from any and all claims arising from the use of the photos or videos.

Alternatives to Chiropractic Care

Other treatment options for your condition may include rest, acupuncture, physical therapy, medical care, medications (both over the counter and prescribed), hospitalization, surgery and others. If you choose to use other treatment options, you should discuss the risks and benefits with your medical doctor or other provider.

DO NOT SIGN THIS FORM UNTIL YOU HAVE READ AND UNDERSTAND THIS FORM. UPON DOING SO, PLEASE PRINT, SIGN AND DATE THIS FORM BELOW. IF UNDER 18, PLEASE HAVE A PARENT/GUARDIAN SIGN FOR YOU.