Informed Consent for chiropractic treatment

Your chiropractor is a member of the NCA. This association has a policy regarding the treatment you undergo by your NCA chiropractor. In this perspective we ask you to carefully read this form. If you have any questions you can discuss these with your chiropractor. 

With this form we inform you about the benefits, possible side effects and alternatives to the treatment options offered by your chiropractor and to make an informed decision about proceeding with treatment. 

Chiropractic treatment 

Chiropractic treatment includes adjustment, manipulation and mobilization of the spine and other joints of the body. Chiropractors also master soft-tissue techniques such as massage and trigger point therapy, and other forms of therapy including exercise, postural advice and nutritional advice. 


Chiropractic treatment has been scientifically demonstrated to be effective for complaints of the musculoskeletal system. Treatment by your chiropractor can relieve pain – including neck and back pain – headache, altered sensation, muscle stiffness and spasm. The treatment can also increase mobility, improve function, and reduce or eliminate the need for drugs or surgery. 

Possible risks 

Chiropractic is very safe form of care. The risk of ill effects is quite low. However, they do sporadically occur and it is important that you are familiar with these before you consent to treatment. The side effects associated with chiropractic treatment vary according to each patient’s condition as well as the type of treatment. The possible side effects include: 

● Common: Temporary worsening of symptoms. Usually, any increase in pre-existing symptoms of pain or stiffness will last only a few hours to a few days. 

● Sometimes: Sprain or strain. Typically, a muscle or ligament sprain or strain will resolve itself within a few days or weeks with some rest, protection of the area affected and other minor care. 

● Rare: Rib fracture. While a rib fracture is painful and can limit your activity for a period of time, it will generally heal on its own over a period of some weeks without further treatment or surgical intervention. 

● Very rare: Aggravation of a herniated disc. Serious complications are rare in chiropractic. Therefore it is often not possible to determine if a worsening of symptoms is due to a treatment or the natural cause of the disc issue. In the most severe cases, patient symptoms may include impaired back or neck mobility, radiating pain and numbness into the legs or arms, impaired bowel or bladder function, or impaired leg or arm function. Surgery may be needed. 

● Extremely rare: Stroke: In extremely rare instances, a person may have a dissection of a blood vessel (artery). Dissection is a separation of the interior wall from the outer wall of the artery. In the most severe form, this can result in a stroke with a number of outcomes, including impairment and death. A dissection is often undetectable before any stroke-like symptoms occur. Many common activities of daily living involving ordinary neck movements (coughing, sneezing, looking at the sky, doing sports and neck manipulation) have been associated with stroke resulting from damage to an artery in the neck. According to the current literature these movements do not cause dissection – the underlying reason is unknown. 

Chiropractic treatment has also been associated with stroke. However, that association occurs very infrequently: 1 in 1 million or less (0,0001%). Current scientific evidence has established that chiropractic treatment does not increase risk of damage to an artery or stroke. 


Your chiropractor is accomplished in a number of different techniques to suit your specific treatment goals. These include manipulation, mobilization, activator, trigger point therapy, exercises etc. A treatment plan will be discussed with you. If you have any questions about the techniques your chiropractor uses, feel free to ask about them. Naturally, you can always consider not undergoing treatment. Alternatives to chiropractic care may include (pain) medication or referring to other health care professionals. 

Questions or Concerns 

You are encouraged to ask questions at any time regarding your assessment and treatment. Bring any concerns you have to the chiropractor’s attention. Please be involved in and responsible for your care. Inform your chiropractor immediately of any change in your condition.