Welcome to Clearview Chiropractic Life Center! Please read this carefully so you will know what to expect during your first 2 visits. Over 90% of our new patients are referred by current members of our practice, which means the world to us! We look forward to sharing the Chiropractic Lifestyle and How to Get Well & Stay Well with you and your family!
What to Expect at Clearview Chiropractic Life Center
Day 1: Consultation & Exam
- Today’s visit should take approximately 40 minutes
Personal Consultation with the Doctor, Complete Biomechanical Exam, and if necessary X-rays will be performed to help the Doctor know exactly how to best help you.
We will discuss your health history to fully understand your current condition as well as to discover hidden events or lifestyle choices that may be impacting your health
All fees will be discussed with you in advance. We require payment for today’s services at the end of the appointment
At checkout, you will need to schedule your Doctor’s Report
Day 2: Doctor’s Report and Best Recommendations
- You will be given a specific description of the condition of your spine and nervous system and how these findings impact your current and future health
The beginning portion of this report may be in a group setting, so please arrive on time. All of your personal information is discussed in private with the Doctor.
The Doctor’s report details the solutions available to maximally correct your problems. If Subluxation is confirmed, your first adjustment will be recommended on this visit.
This report is scheduled on very specific days/times, and takes approx. 45 mins -1 hour
A financial decision regarding your care will need to be made at this time.
Please bring your spouse/significant other if possible. It is critical to the success of your case that your spouse/significant other sees and understands this information so they are able to support you through this process. (A work excuse can be provided if needed for you or your spouse/significant other).
Select options below indicating age at diagnosis and other relevant details.
What is the most significant thing you can do to improve your health?
How committed are you at achieving your maximum health potential?
How do you want us to handle your problem?
Please read the following carefully before signing.
The statements made on this form are accurate to the best of my recollection and I agree to allow this office to examine me for further evaluation. I understand that I am responsible for all payment of fees charged in this office of services rendered.
Privacy Act: I consent to the use of my protected health information by Dr. Robertson for the purpose of analyzing, diagnosing or providing treatment to me, obtaining payment for my health care bills or conduct health care operations. I understand that the Notice of Privacy Practices is posted on www.clearviewchiropractic.net and in the office at the front desk, and I may request a written copy. HIPAA Compliance.
TERMS OF ACCEPTANCE:
When a patient seeks chiropractic care and we accept a patient for such care, it is essential for both to be working for the same objective.
Chiropractic has only one goal. It is important that each patient understands both the objective and the method that which will be used to attain it. This will prevent any confusion or disappointment.
Adjustment: The adjustment is the specific application of forces to facilitate the body’s correction of a vertebral subluxation. Our Chiropractic method of correction is by specific adjustments to the spine.
Health: The state of optimal physical, mental, and social well-being, not merely the absence of disease or infirmity.
Vertebral Subluxation: A misalignment of one or more of the 24 vertebra in the spinal column which causes alteration of nerve function and interference to the transmission of mental impulses, resulting in a lessening of the body’s innate ability to express its maximum health potential.
We do not offer the diagnosis or treatment of any disease. We only offer to diagnose either vertebral subluxation complex and/or neuro-musculoskeletal conditions. However, if during the course of a chiropractic spinal examination we encounter unusual finding which are outside the scope of practice for a Doctor of Chiropractic, we will advise you. If you desire advice, diagnosis, or treatment for those findings, we will recommend that you seek the services of another health care provider.
Regardless of what the disease is called, we do not offer to treat it. Nor do we offer advice regarding treatments prescribed by others. OUR ONLY PRACTICE OBJECTIVE is to eliminate major interference to the expression of the body’s innate wisdom. Our only method is the specific adjustment to correct vertebral subluxation. And we may use other procedures to help your body hold those adjustments.
* Please read and agree to the terms
Today's Date: 18 Jun 2019