Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com

AN EDUCATED CLIENT IS HEALTHY CLIENT

 

Thanks for trusitng our wellness centre with you and your family's healthcare needs.

 

I started practicing in 2003. I have been passionate about helping patients of all ages experience the positive benefits of chiropractic care. Our mission is to educate patients about what chiropractic care is. Chiropractic is part of your lifestyle — who you are. We believe chiropractic is something you should be doing to maintain and promote your health. I've had this clinic here in Burnaby since 2008, and I enjoy seeing patients of all ages become proactive about their health so they can feel their best

 

 

We are conveniently located in Burnaby, patients can quickly and easily get to Holdom Chiropractic & Wellness Centre from any location. We are within walking distance to the Holdom Skytrain Station on the Millennium line and are in a pedestrian-friendly area. Our environment is welcoming and has an upbeat vibe so you and your family can feel comfortable and at home while getting care. We’ll always take the time to get to know you. You’ll be treated more like a friend than a number or a last name. In addition to chiropractic, we offer acupuncture, massage therapy, orthotics, prenatal and pediatric care and sports chiropractic.

 

Get ready to feel your best with natural chiropractic care.

Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
The symptoms that have prompted you to seek care today include:
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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
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Rate the severity of your pain from 0 to 10

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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
Type of Pain
Front Head

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Front Left Ankle

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Front Left Hand

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Front Left Wrist

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Back of Head

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Back Left Neck

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Upper Back

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Back Left Shoulder

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Mid-Back

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Back Right Ribs

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Back Left Ribs

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Lower Back

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Back Right Hip

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Back left Glute

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Back Right Knee

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Back Left Knee

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Back Right Lower Leg

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Back Left Lower Leg

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Back Right Ankle

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Back Left Ankle

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Bottom of Right Foot

Please specify specific areas

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Bottom of Left Foot

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Type of Pain
Back Right Upper Arm

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Back Left Upper Arm

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Back Right Elbow

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Back Left Elbow

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Back Right Forearm

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Back Left Forearm

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Back Right Hand

Please specify specific areas

Type of Pain
Back Left Hand

Please specify specific areas

Type of Pain
Back Right Wrist

Type of Pain
Back Left Wrist

Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
Select options below indicating age at diagnosis and other relevant details.
Musculoskeletal
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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
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Holdom Chiropractic & Wellness Centre
111-2251 Holdom Ave
BURNABY, BC V5B 0A2
(604) 298-1777
dcronuppal@hotmail.com
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Please read the following carefully before signing.

 

INFORMED CONSENT TO CHIROPRACTIC CARE

 

HOLDOM CHIROPRACTIC

 

 

 

Doctors of chiropractic who use manual therapy techniques are required to advise patients that there are or may be some risks associated with such treatment. In particular you should note:

 

 

 

A)       While rare, some patients may experience short term aggravation of symptoms, rib fractures or muscle and ligament sprains or strains as a result of manual therapy techniques;

 

 

 

B)       There are reported cases of stroke associated with many common neck movements including adjustment of the upper cervical spine. Present medical and scientific evidence does not establish a definite cause and effect relationship between upper cervical spine adjustment and the occurrence of stroke. Furthermore, the apparent association is noted very infrequently. However, you are being warned of this possible association because stroke sometimes causes serious neurological impairment, and may on rare occasion result in injuries including paralysis. The possibility of such injuries resulting from upper cervical spinal adjustment is extremely remote;

 

 

 

C)       There rare reported cases of disc injuries following cervical and lumbar spinal adjustments although no scientific study has ever demonstrated such injuries are caused, or may be caused, by spinal adjustments or chiropractic treatment.

 

 

 

Chiropractic treatment, including spinal adjustments, has been the subject of government reports and multidisciplinary studies, conducted over many years and has demonstrated to be effective treatment for many neck and back conditions involving pain, numbness, muscle spasm, loss of mobility, headaches and other similar symptoms. Chiropractic care contributes to your overall well being. The risk of injuries or complications from chiropractic treatment is substantially lower than that associated with many medical or other treatments, medications, and procedures given for the same symptoms.

 

 

 

I acknowledge I have discussed, or will have the opportunity to discuss, with my chiropractor the nature and purpose of chiropractic treatment in particular (including spinal adjustments) as well as the contents of this Consent.

 

 

 

I consent to the chiropractic treatments offered or recommended to me by my chiropractor, including spinal adjustments. I intend this consent to apply to all my present and future chiropractic care.

 

 

 

Dated this _________________ day of _____________________________, 20____

 

 

 

 

 

        _________________________________                ______________________

* Please read and agree to the terms
Signature
Today's Date: 25 Apr 2018