I consent to care at this clinic. I understand that I have the opportunity to discuss with the medical team and/or with the office personnel, the nature and purpose of regenerative medicine, chiropractic adjustments and other wellness therapies. I hereby request and consent to regenerative treatments and/or with chiropractic procedures, including various modes of physiotherapy, diagnostic x-rays, and any supportive therapies on me ( or on the patient above, for whom I am legally responsible) by staff. I also understand that as is with all healthcare treatments, results are not guaranteed, there is no promise to cure and that there are some risks. Risks include but are not limited to: aggravating and/or temporary increase in symptoms, muscle spasms, fractures, disc injuries, strokes, dislocation, and sprains. I do not expect the staff to be able to anticipate and explain all risks and complications, and I wish to rely on the staff's judgment, based upon the facts and/or correct specific conditions allowing the body to return to improve health. They can also alleviate certain symptoms through a conservative approach with hopes to avoid more invasive procedures. I have read, or have had read to me, this consent. I have also had the opportunity to ask questions about its content, and by signing below, I agree to the procedures named above.