Patient Informations

Please circle areas to the right where you have pain or other symptoms:

On the arrow diagram above:

What are your health goals?

Chiropractic is one of the most widely used drug free health care professions in the world. For your own awareness we have chosen to inform you
of very unlikely but possible risks associated with chiropractic.

• Very rare risks may include post adjustment muscle soreness, strain to a ligament or disc in the neck/lower back, and possible
  aggravation of underlying conditions.
• Extremely rare is the risk of damage to neck blood vessels which can arise in a stroke or stroke- like symptoms.

Chiropractic adjustments of the spine are internationally recognised as being far safer statistically than medication and other alternatives. If you
have any questions relating to the care you are about to receive, please speak to your chiropractor.

I acknowledge the above information and do not expect the chiropractor to be able to anticipate all potential risks and complications. Based on the
information provided, I consent to and look forward to receiving chiropractic care in this office, if required.

Risk Ratios & Statistics: Cervical Spine

(Neck)

-(Temporary) Radiculopathy associated with disc injury -1:139,000 

-Vascular injury  -1:5.85 million 

Lumbar Spine

-Disc injury with radiating pain    1:62,000 

-Radiculopathy    1:188,000

-Cauda Equina syndrome  1:565,000

In comparison

Hospitalisation for gastro intestinal bleeding (NSAID) (following 1 month of medication)   1:250 

-Deaths associated with NSAIDS (US) 3200pa (AUST)  360 pa

-Deaths from general anaesthetic  1:1250

-Injury from motor vehicle accidents  1:9300 

-Hospitalisation from adverse drug reactions  20,000 – 26,000 pa