I hereby consent to give the doctor of chiropractic, and anyone working in the Excelsior Family Chiropractic office authorized by the chiropractor, permission and authority to care for me. Chiropractic tests, diagnosis, analysis, and adjustments are very safe and beneficial and rarely cause any risks. In rare cases, underlying physical defects, deformities or pathologies may make the Practice Member prone to injury. It is the responsibility of the practice member to make it known, or to learn through health care procedures if he or she is suffering from latent pathological defects, illnesses, or deformities, which would otherwise not come to the attention of the chiropractor. The doctor of chiropractic will not give any treatment or care if he or she is aware that such care should not be used for a particular condition or circumstance. Your doctor of chiropractic is a licensed primary care provider, and is available to work with all other types of providers. I understand that if I am accepted as a Practice Member at Excelsior Family Chiropractic, I am authorizing them to proceed with any treatment that they deem necessary. I understand that following the doctor’s recommended care plan is essential to maximizing my healing and reaching optimal health through chiropractic. Furthermore, any questions that I have regarding chiropractic care, will be explained to me upon my request.