Consent to care 

It is our responsibility as allied health professionals to inform you of possible risks that can be associated with manual techniques that may be used during a treatment session here at Revibe Chiropractic.

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

Please read the following statements regarding the care provided by your Chiropractor:

  • You may be asked questions of a personal nature with regards to how your current pain/ailments restrict your activities of daily living. You may answer at your discretion.

  • Physical contact may be necessary during your assessment and treatment. Your therapist will always ask your permission before making physical contact in any way. Wherever possible, contact will be made using a towel or other form of screening. Physical contact requires your direct consent. You may withdraw consent at any time at which point, all physical contact will cease immediately. Please inform your therapist if you feel uncomfortable at any time.

  • As with all forms of treatment, there are risks and benefits. Your therapist will discuss any foreseeable risks with you prior to administering treatment. In some cases, your therapist may ask you to read information related to a specific treatment, such as dry needling and cupping. They may request that you sign a further consent form. This is to ensure that you fully understand any risks involved.

  • The risk related to some treatments can increase if the therapist is not aware of certain facts regarding your past medical history.

Please inform the therapist if you have:

  • A pacemaker or heart condition

  • Suffered from blood clots, thrombosis or stroke in the past

  • Suffer from diabetes

  • Are currently taking any medication, especially blood thinners and long-term use steroids

Late Cancellation Fee – We want you to get better. Your ideal outcome is dependent on maintaining the management plan outlined by your therapist. If you need to change or reschedule an appointment, please give us 24-hour notice so we may organize an appointment for someone else in that time. If you’re unable to do so there will be a late notice cancellation fee.

Some manual techniques such as deep tissue massage, joint adjustments, traction/distraction or mobilizations have a very small risk of causing injury. Injury may be caused to structures including, but not limited to; nerves, bones, muscles, ligaments, intervertebral discs or arteries. The use of tape or massage mediums may cause irritations or allergic reactions on the skin of some individuals. Where possible, hypoallergenic tapes and massage mediums will be used to further reduce the risk of this occurring.

Dry Needling and the use of acupuncture needles, along with the aforementioned techniques can occasionally cause localized swelling, bruising, or temporary increase in the levels or distribution of pain or other symptoms.

I acknowledge that I have/will discuss with my therapist the rare risks associated with my proposed care which include but are not limited to:

  • muscle and joint soreness or strains,

  • exacerbation/aggravation of my underlying condition.

  • nausea and dizziness,

  • fractures particularly in people with bone weakening diseases.

  • disc injuries including disc encroachments/ruptures, causing nerve irritation and referred symptoms,

  • strokes (or like episodes) – Although rare it is a documented risk to care. Current statistics estimate a 1 in 5.85 million risk- Haldeman, et al. Spine vol 24-8 1999.

Such risks may result in outcomes such as referral, further tests, surgery or incapacity.

You may choose to consent or refuse any form of treatment for any reason including religious or personal reasons. Once you have given consent, you may withdraw that consent at any time.

I have read and understand the above statements relating to consent for Physiotherapy/Chiropractic/Massage treatment. By signing this document, I give CONSENT for treatment unless I express withdrawal of that consent. I have had opportunity to ask questions about my treatment including its risks.