Dr. Gina Wolf • Dr. Christopher Melich • Dr. Patricia Fichter
15404 E. Springfield Ave Suite 100, Spokane Val ey, WA 99037
phone 509.892.9800 • fax 509.892.9998 Informed Consent
Before beginning treatment, it is our office policy to inform you of what to expect, possible complications of chiropractic,
as well as other forms of treatment. Remember that al forms of treatment (including non-treatment) have associated
risks. If you have any questions, please ask the doctor. WHAT TO EXPECT
The treatment in our office will consist of manipulation of the joints and soft tissues (muscles and ligaments), using the
doctor’s hands and/or a mechanical instrument. You may feel movement, and you may hear joint clicks or other noises.
Physical therapy methods, including therapeutic exercise, massage and heat or ice may also be used.
Chiropractic treatment is one of the safest methods of treating spinal problems. Still, unexpected problems can occur.
Minor, temporary problems such as soreness and stiffness can occur, especially at the start of treatment. More significant
problems, such as fracture of a weakened bone or sprain/disc injuries are rare. A stroke following neck manipulation
is an extremely rare complication, occurring less than 1 per million treatments. Stroke has also been the result of
ordinary activities, such as head turning and sneezing.
OTHER TREATMENTS AND RISKS
There are other forms of treatment used by medical doctors. Their risks include:
Medications: Many commonly used medications such as NSAIDs (Advil, Aleve, and Ibuprofen) carry risks of tissue
damage, including stomach ulcers or kidney damage. This damage can occur quickly and may be irreversible. There are
significantly higher risks of developing serious complication with NSAIDs compared with chiropractic. The annual number
of hospitalizations for serious GI complications related to NSAIDs is estimated to be at least 103,000. Conservative
estimates of NSAID-related deaths in the US are 16,500 per year. New England J Med 1999
Other medications are habit forming, and may mask pain to al ow further injury or tissue damage.
Surgery: Surgery is the treatment of choice in less than 1% of back pain patients. Your doctor wil and continue to
screen you for surgical indicators and will refer you for a surgical opinion if necessary. Clinical results of surgery for
simple, mechanical lower back pain have been disappointing and may expose you to unnecessary hospital and medication
Rest/ Non-Treatment: Bed-rest has been shown to increase the likelihood of recurrence of back pain episodes, and
make chronic pain more likely. Likewise, non-treatment may cause a permanent mechanical problem to develop, causing
I have read and understand the above, and give my consent to begin chiropractic treatment. Printed Name_______________________________________ Date_____________________________ Signature___________________________________________________________________________
HEALTH SERVICES POLICY & PROCEDURE MANUAL To assure that DOP inmates with Soft Tissue Infections are receiving high quality Primary Care for their infections and that the risk of infecting other inmates or staff is minimized. All DOP Primary Care Providers are expected to follow this guideline and/or will document in the medical record any deviations from this guideline and the
Gastroparesis -- This condition occurs when the rate of the electrical wave slows and the stomach contracts less frequently. Now the food just lays in the stomach relying on acid and digestive enzymes to break down the food and on gravity to empty the stomach. There are a number of causes for this condition: Diabetes is the most common known cause. Adrenal and thyroid gland problems can a