Form Cms-R-131 - Application For Peripheral Neuropathy Treatment (Page 7 of 10) in pdf

Form Cms-R-131 - Application For Peripheral Neuropathy Treatment Page 7

Chiropractic Terms of Acceptance

When we accept you as a patient into our practice, it is important that you understand the objectives of our care.

Chiropractors provide a unique service that other healthcare providers do not offer: the location and correction of

vertebral subluxations (spinal nerve stress) in your body.

A vertebral subluxation is a misalignment or distortion of your spinal column or related structures that can affect your

brain, nervous system and overall body function. Subluxations can cause disease or loss of proper body function.

Chiropractors spend years studying how to locate and correct this destructive condition, first by analyzing your body

structure (especially your spine) using various methods. Second, we correct or adjust your subluxations by using specialized

technique (spinal adjustment). When your spine and nervous system are free from the deep stress of vertebral subluxations

you function more efficiently and your natural healing ability, your inner healer, will better communicate through your

body.

We do not medically diagnose or treat any disease, symptom or condition. No matter what condition(s) you may have

been diagnosed with and no matter what symptom(s) your body is expressing, you always need a body free from

subluxations.

If, during the course of our chiropractic spinal examination, we encounter unusual findings, we will let you know of

them. You may then decide whether you wish to investigate further and discuss your healthcare options with other

healthcare professionals. We will cooperate with you and with them in your goals.

To summarize: the purpose of chiropractic care is not to treat diseases or conditions, nor to suppress symptoms, nor to

perform surgery, but rather to make your body function better by removing spinal nerve stress (subluxations). Therefore we

do not prescribe surgery or medications. If you wish to decrease or stop medications you should discuss that with your MD.

Our objective is to eliminate a major interference to the expression of your physical/emotion health and healing

vertebral subluxations so that your natural healing ability and your inner healer may function without this severe form of

stress.

By signing below, you are confirming that you have had the opportunity to read and understand the “Chiropractic Terms

of Acceptance”.

____________________________________________________________________________________

Signature

Date

Form Cms-R-131 - Application For Peripheral Neuropathy Treatment Page 7