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Dr. Jason E. Key, D.C. 2008 3rd Street, Suite B La Grande, OR 97850 Phone: 5419639632 Fax: 5419636346 http://drkehr.com/ INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to
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How to fill out chiropractic informed consent form

01
Start by reading the chiropractic informed consent form carefully to understand the information it requires.
02
Provide your personal information such as your name, date of birth, address, and contact details.
03
Indicate any relevant medical history, including previous injuries or conditions, surgeries, medications, and allergies.
04
Review the list of chiropractic treatments and procedures mentioned in the form, and mark your consent or refusal for each.
05
Make sure to ask any questions or seek clarification regarding the treatments or procedures before signing the form.
06
Sign and date the chiropractic informed consent form to indicate that you understand the risks and benefits associated with chiropractic care.
07
If required, provide the name and contact information of your medical insurance provider.
08
Keep a copy of the signed form for your records and provide a copy to the chiropractor.

Who needs chiropractic informed consent form?

01
Anyone seeking chiropractic care should complete a chiropractic informed consent form.
02
This includes individuals who are new to chiropractic treatment, as well as those who have received chiropractic care in the past.
03
The form ensures that patients are aware of the potential risks and benefits of chiropractic procedures and can make informed decisions about their healthcare.
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The chiropractic informed consent form is a document that outlines the risks, benefits, and alternatives to chiropractic treatment, ensuring that patients are fully informed before undergoing care.
Chiropractors are required to have patients fill out and sign the chiropractic informed consent form prior to providing treatment.
To fill out the chiropractic informed consent form, patients should provide their personal information, review the outlined treatment options, risks, and benefits, and then sign the form to indicate their understanding and agreement.
The purpose of the chiropractic informed consent form is to ensure that patients are aware of the nature of the treatment, potential risks, and benefits, thereby protecting both patients and practitioners legally.
The chiropractic informed consent form must include patient information, a description of the proposed treatment, an explanation of potential risks and benefits, and the patient's signature acknowledging their understanding.
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