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Chiropractor Care Consent Form

905-901-0009
bodyflexclinic@gmail.com
3050 Confederation Pkwy #201, Mississauga, ON L5B 3Z6, Canada

Informed Consent for Chiropractic Care

"*" indicates required fields

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HEALTH HISTORY FORM

Please check if you suffer from, previously suffered from, or are concerned you suffer from any of the following:-

Musculoskeletal*
Cardiac*
Respiratory*
Digestive*
Women’s Health*
Other*

Doctor 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: While rare, some patients may experience short term aggravation of symptoms, rib fractures or muscle and ligament strains or sprains as a result of manual therapy techniques; 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; There are rare reported cases of disc injuries following cervical and lumbar spinal adjustment although no scientific study has ever demonstrated such injuries are caused,ormaybecaused,by spinal adjustments or chiropractic treatment. Chiropractic care, including spinal adjustment, has been the subject of government reports and multi- disciplinary studies conducted over many years and has been demonstrated to be effective treatment for many neckandbackconditionsinvolvingpain,numbness,musclespasm,lossofmobility,headaches and other similar symptoms. Chiropractic carecontributestoyouroverallwellbeing.Theriskofinjuries 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 have had the opportunity to discuss,with my chiropractor the nature and purpose of chiropractic treatment in general and my treatment in particular (including spinal adjustment) as well as the contents of this Consent. I consent to the chiropractic treatments offered or recommended to me by my chiropractor, including spinal adjustment. I intend to apply to all my present and future chiropractic care.

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What Our Patients Have to Say

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Sunny Fayaz
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Amazing work
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michie publico
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I came to the clinic for my appointment, and my experience was amazing! The staff were very friendly, welcoming, and professional. I felt comfortable and well taken care of throughout my visit. I’m very happy with the service and would definitely recommend this clinic to others.
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Juraj Foltin
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⭐⭐⭐⭐⭐ A True Hidden Paradise of Healing and Relaxation After experiencing Rania's incredible massage work in the past, I couldn't wait to visit her new clinic. What she and her partner have created is truly extraordinary. From the moment you walk in, you can feel the passion, love, and countless hours of hard work that went into every detail. The beautiful stone-inspired walls, the stunning maple leaves in the epoxy floor, the elegant décor, and even the carefully chosen touches in the bathroom create an atmosphere that feels more like a luxury spa retreat than a clinic. There's even an amazing massage chair and a welcoming sitting area with fresh fruit that make you feel instantly relaxed. And then there's Rania. She remains one of the most talented massage therapists I've ever met. Her ability to find problem areas and provide immediate relief is remarkable, and her genuine care for her clients shines through in every treatment. If you're looking for more than just a massage, if you want an experience that combines healing, relaxation, and beauty, this is the place. Rania and her partner have created a little piece of paradise. Highly recommended! ❤️
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Eva Dzionek
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I had a massage at the clinic. Super nice staff and decor makes you feel so relaxed. There’s coffee and treats. From the moment you step into the office you are transformed. A must see for yourself! Highly recommend.
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K K profile picture
K K
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Best place that will meet all your needs. I was a previously client from before and will continue going with them. They are a further drive from me but it is worth it for me. Can’t put a price on quality and service ! Thank you Rania !
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Imran Malik profile picture
Imran Malik
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Excellent service and total relief for my back pain. If you're dealing with soreness or tension, this is the place to go.
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Zoey Yang profile picture
Zoey Yang
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⭐️⭐️⭐️⭐️⭐️ I had such a wonderful experience at Bodyflex Physio & Rehab Clinic! From the moment I walked in, I felt very welcomed and comfortable. The clinic is beautiful, clean, relaxing, and has such a warm atmosphere. What impressed me the most was the service. Everyone was friendly, professional, patient, and truly cared about making sure I had a great experience. You can really feel that they put their heart into taking care of their clients. I’m extremely happy with the service I received and would definitely recommend Bodyflex to anyone looking for a professional and caring wellness and rehabilitation clinic. I will absolutely be coming back! ❤️ Thank you to the whole Bodyflex team for such a wonderful experience! Highly recommended! 🌟
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Nermine Kaldas
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It is a pleasure to share my experience with this establishment. The ambiance is wonderfully serene and impeccably clean, contributing to a truly relaxing atmosphere. The professionalism of the staff is evident in every interaction, and their service is exceptionally good. The entire team is friendly and attentive, ensuring a pleasant visit. I highly recommend this place for a rejuvenating experience.
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A multidisciplinary rehabilitation clinic on Confederation Parkway in Mississauga, Ontario.

Body Flex Physio and Rehab Clinic is a multidisciplinary rehabilitation clinic located in Mississauga, Ontario. We offer physiotherapy, chiropractic care, acupuncture, osteopathy, naturopathic medicine, registered massage therapy, MVA rehabilitation, orthopedic rehabilitation, and compression stocking fitting. We accept motor vehicle accident (MVA) and WSIB claims and offer direct billing to most insurance providers. Conveniently located at Unit 201, 3050 Confederation Pkwy — serving Cooksville, Square One, City Centre, Fairview, Applewood, and all of Mississauga.

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