Patient Informed Consent

Patient name­­____________________________________

Advanced Back Center 
303 E. Army Trail Rd.
Suite 407
Bloomingdale, IL 60108


The primary treatment used by doctors of chiropractic is the spinal adjustment.  I will use that procedure to treat you.

*The nature of chiropractic adjustment.

I will use my hands or a mechanical device upon your body in such a way as to move your joints.  That may cause an audible “pop” or “click,” much as you have experienced when you “crack” your knuckles.  You may feel or sense movement.

*The material risks inherent in chiropractic adjustment.

As with any health care procedure, there are certain complications that may arise during a chiropractic adjustment.  Those complications include: fractures, disc injuries, dislocations and muscle strain, Homer’s syndrome, diaphragmatic paralysis, cervical myelopathy, and costovertebral strains and separations.  Some types of manipulation of the neck have been associated with injuries to the arteries in the neck leading to or contributing to serious complications, including stroke.  Some patients will feel some stiffness and soreness following the first few days of treatment.

*The probability of those risks occurring.

Fractures are rare occurrences and generally result from some underlying weakness of the bone, which we check for during the taking of your history and during examination and X-rays.  Stroke has been the subject of tremendous disagreement within the profession with one prominent authority saying that there is at most a one-in-a-million chance of such an outcome.  Since even that risk should be avoided if possible, we employ tests in our examination that are designed to identify if you may be susceptible to that kind of injury.  The other complications are also generally described as “rare.”



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