Informed Consent

I hereby consent to the performance of Chiropractic adjustments and any other Chiropractic procedures including, but not limited to, examination testing, Active Release Technique, manual manipulations, Graston Technique, cold laser treatment, ARPwave therapy, which are recommended by the doctor of Chiropractic who now, or in the future, render treatments to me while employed by and/or associated with All Pro Health, LLC.

I understand that, as with any healthcare procedure, there are certain complications which may arise during treatments. These complications include, but are not limited to, soreness, bruising, fractures, disc injuries, disc dislocations, muscle strain, Homer’s syndrome, diaphragmatic paralysis, cervical myelopathy, and costovertebral strains and separations. Some types of manipulations of the neck have been associated with injuries to the arteries in the neck leading to, or contributing to, serious complications, including stroke. I do not expect the doctor to be able to anticipate all risks and complications during my treatment, and I wish to rely on the doctor to exercise judgment during the course of the procedure(s) which the doctor feels, at the time, based upon facts known, is(are) in my best interest.

I have had the opportunity to discuss with the doctor(s) named below, and/or the office personnel, the nature, purposes, and risks of Chiropractic adjustments and other recommended procedures. I understand the results are not a guarantee of permanent relief.

I have read, or have had read to me, the above explanation of Chiropractic adjustments and related treatments. By signing below, I state that I have weighed the risks involved in undergoing treatment and have, myself, decided that is in my interest to undergo ant treatment that may be recommended. I intend this consent to form to cover the entire course of treatment of my present condition(s) and for any future condition through which I seek treatment.

Name and Address of Facility
All Pro Health, LLC
381 Walnut Street
Livingston, NJ 07039

Name(s) of Doctor(s)
Todd E. Schragen DC, CCSP

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