To help us prepare for your visit, please complete your new patient intake form before your appointment. This gives Dr. B a clearer picture of your health history, symptoms, concerns, and care goals so your first visit can be more focused, efficient, and personalized.
It should only take about 5–10 minutes.
McLeod Street Chiropractic
343 McLeod St, Greater Sudbury, ON P3E 1S5(705) 910-0040
343 McLeod St, Greater Sudbury, ON P3E 1S5
(705) 910-0040
Does your condition or concern affect any of the following?
Please select the option that best describes how each activity is affected.
Check any that apply.
Please select any health history items that apply to you or your family members. This helps Dr. B review relevant past health information and better understand your overall health picture before your visit. You may select multiple options, or choose “None” if nothing applies.
You are the decision-maker for your health care.
One of our roles at McLeod Street Chiropractic is to provide you with information that helps you make informed choices about your care. This process is commonly referred to as informed consent.
Informed consent means you understand and agree to the examination, assessment, recommended care, potential benefits, possible risks, available alternatives, and possible effects of choosing not to receive care.
Before receiving chiropractic care, a health history and physical examination will be completed. These procedures are performed to help the doctor better understand your current condition, overall health, spine and nervous system function, and whether chiropractic care may be appropriate for you.
The examination may include, but is not limited to, consultation, posture and movement assessment, orthopedic testing, neurological testing, spinal evaluation, range-of-motion testing, palpation, and other procedures the doctor determines are appropriate. If the doctor believes further evaluation, imaging, or referral to another health care provider is required, this will be discussed with you.
All relevant findings will be reviewed with you, and a recommended care plan will be explained before care begins. You have the right to ask questions at any time, refuse any part of the examination or care, request more information, seek another opinion, or withdraw consent at any time.
Chiropractic care may include chiropractic adjustments, spinal or extremity mobilization, soft-tissue therapies, instrument-assisted techniques, stretching, exercise recommendations, posture or lifestyle recommendations, rehabilitation guidance, and other supportive procedures provided in our office.
Chiropractic care commonly involves what is known as a chiropractic adjustment. An adjustment may be performed by hand or with an instrument. The purpose of an adjustment is to help improve joint motion, reduce mechanical irritation, support better movement, reduce discomfort, and improve function.
Potential benefits of chiropractic care may include, but are not limited to, reduced pain or discomfort, improved spinal or joint mobility, improved posture and movement, reduced muscle tension, improved ability to perform daily activities, improved function, and improved overall well-being.
However, as with all forms of health care, results are not guaranteed. McLeod Street Chiropractic does not promise, guarantee, or represent that chiropractic care will cure any condition or produce a specific result.
Although chiropractic care is generally considered safe when properly performed, all health care procedures carry some level of risk. Risks associated with chiropractic care are usually minor and temporary, but in rare cases may be more serious.
Possible risks, side effects, or complications may include, but are not limited to, temporary soreness or stiffness, temporary increase in pain or symptoms, muscle tightness or spasms, headache, fatigue, dizziness or lightheadedness, nausea, bruising or tenderness, skin irritation, aggravation of a pre-existing condition, strains or sprains, disc irritation or disc injury, nerve irritation, rib or bone fracture particularly in patients with weakened bones or underlying conditions, dislocation, burns or skin irritation from supportive therapies such as heat, ice, or electrical stimulation if used, lack of improvement in symptoms, and the need for referral to another health care provider.
Certain health conditions may increase the risks associated with chiropractic care. These may include, but are not limited to, osteoporosis, bone weakness, cancer, infection, inflammatory arthritis, bleeding disorders, use of blood-thinning medication, recent surgery, significant trauma, vascular conditions, neurological symptoms, pregnancy-related considerations, or other medical conditions.
You agree to fully and honestly disclose your health history, current symptoms, medications, allergies, past accidents, surgeries, illnesses, and any changes in your condition. This information is important so the doctor can determine whether chiropractic care is appropriate, whether care should be modified, or whether referral is needed.
With respect to neck pain, headaches, and cervical spine care, it is important to understand that rare but serious vascular events, including arterial dissection and stroke, have been reported in association with a wide variety of everyday activities and health care visits. These events may occur in people whether or not they receive chiropractic care.
An arterial dissection is a rare condition involving a tear in the inner layer of an artery. This can lead to the formation of a clot and, in some cases, a stroke. Patients experiencing an arterial dissection may sometimes present with neck pain, headache, dizziness, or other symptoms before a stroke occurs.
Current scientific understanding supports that chiropractic adjustment does not cause dissection in a normal, healthy artery. However, some people may have underlying disease processes, genetic factors, vascular abnormalities, medication effects, or other health conditions that make arteries more vulnerable.
Because some serious conditions may first appear as neck pain or headache, it is important that you immediately report any unusual symptoms, including but not limited to sudden severe headache, sudden severe neck pain unlike anything you have experienced before, dizziness or loss of balance, blurred vision or vision changes, difficulty speaking, difficulty swallowing, facial drooping, numbness or weakness in the face, arm, or leg, confusion, fainting, loss of coordination, new or worsening neurological symptoms, loss of bowel or bladder control, numbness in the groin or saddle area, progressive weakness, fever, chills, unexplained weight loss, or pain following significant trauma.
If any of these symptoms occur, emergency medical attention may be required.
You also understand that there are alternatives to chiropractic care. These may include, but are not limited to, doing nothing at this time, self-care, rest, stretching, exercise, over-the-counter pain relief, prescription medication, medical assessment, physiotherapy, massage therapy, bracing or supports, injection therapy, diagnostic imaging, surgical consultation, care from another regulated health professional, or emergency medical care when appropriate.
You understand that choosing not to receive care may result in no change, worsening symptoms, continued discomfort, reduced mobility, delayed recovery, or progression of the underlying issue depending on your condition.
You have the right to ask questions before, during, or after care, receive an explanation of the recommended care, refuse care or withdraw consent at any time, request that care be modified, seek a second opinion, be referred to another provider when appropriate, and stop treatment at any time.
By signing below, you confirm that you have read and understood this informed consent, have had the opportunity to ask questions, have had your questions answered to your satisfaction, understand the nature, purpose, benefits, risks, and alternatives to chiropractic care, understand that results are not guaranteed, and consent to the examination, assessment, and chiropractic care recommended and provided by McLeod Street Chiropractic.
You also understand that you may withdraw consent at any time.