Informed Consent and Acknowledgment of Risk
By submitting this form on the page, I acknowledge that I am voluntarily seeking chiropractic care from Utopian MedicineĀ and Dr. Evan Johnson, a licensed chiropractor in the state of Texas. I understand that chiropractic care, including spinal adjustments, soft tissue work, and other associated treatments, is a form of healthcare that focuses on the musculoskeletal and nervous systems.
I understand that:
Release of Liability
I hereby release and hold harmless Dr. Evan Johnson, and its staff from any claims, damages, or liability that may arise from my treatment, except in cases of gross negligence or willful misconduct. I understand that results may vary, and no guarantees have been made regarding my condition or recovery.
Consent to Treatment
I authorize Dr.Ā Evan JohnsonĀ to administer chiropractic treatment as deemed necessary based on my condition. I understand that I have the right to refuse or discontinue treatment at any time.
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