CHIROPRACTIC LIABILITY WAIVER

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:

  1. Chiropractic care involves the adjustment and manipulation of the spine and other joints to improve function and reduce discomfort.
  2. As with any healthcare procedure, there are inherent risks associated with chiropractic treatment, including but not limited to:
    • Temporary discomfort or soreness
    • Sprains or strains
    • Rare but serious complications such as fractures, disc injuries, or stroke (associated with neck adjustments)
  3. The chiropractor will discuss my treatment options and any potential risks, allowing me to make an informed decision about my care.
  4. I have disclosed my full medical history to the best of my ability, including any underlying conditions, previous surgeries, and medications, to ensure safe treatment.

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.

Ā 

Acknowledgment and Submission

By submitting your name & email below, I confirm that I have read and understood this agreement. I agree to proceed with chiropractic care voluntarily and accept the potential risks involved.

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