Spencer Jean, DO(MP) Osteopathic Manipulative Medicine, Inc.

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Transcription:

Spencer Jean, DO(MP) Osteopathic Manipulative Medicine, Inc.

Spencer Jean, DO(MP) Osteopathic Manipulative Medicine, Inc.

Clinic Tel: 519.735.7555 Cell: 519.551-3463 Email: s.jean@manualosteopath.com 11811 Tecumseh Rd. E. Suite #116, Tecumseh, ON N8N 4M7 Osteopathic Manipulative Therapy Manual osteopathy is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal and joints complaints. Although manual osteopathy has an excellent safety record, no health treatment is completely free of potential adverse effects. The risks associated with manual osteopathy, however, are very small. Many patients feel immediate relief following manual osteopathy treatment, but some may experience mild soreness or aching, just as they do after some forms of exercise or massage. Current literature shows that minor discomfort or soreness following soft tissue therapy typically fades within 24 hours. INFORMED CONSCENT TO MANUAL OSTEOPATHIC CARE: DO NOT SIGN THIS FORM UNTIL YOU MEET WITH THE MANUAL OSTEOPATH I hereby request and consent to the performance of osteopathic manual therapy performed by the osteopathic practitioner named. I have had the opportunity to discuss with the osteopathic practitioner named any questions or concerns that I have regarding my condition and any forms of therapy to be administered. I understand that the results are not guaranteed. I understand and am informed that, as in all health care, there are some very slight risks to treatment, including but not limited to, muscle aches and soreness following treatment. I do not expect the osteopathic practitioner to anticipate and explain all risks and complications, and I wish to rely on the osteopathic practitioner to exercise their judgement and understand that all procedures are in my best interests. I have read the above consent. I have also had the opportunity to ask questions about its content, and by signing below, I agree to the above-named procedures. I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment. Name (Please Print) Signature of patient (or legal guardian) Signature of Manual Osteopath Date: Date:

Clinic Tel: 519.735.7555 Cell: 519.551-3463 Email: s.jean@manualosteopath.com 11811 Tecumseh Rd. E. Suite #116, Tecumseh, ON N8N 4M7 Office Policy MISSION STATEMENT Our mission is to provide professional, confidential, high quality service in a relaxed, friendly, and informative environment. Osteovitality is dedicated to your excellence. Whether you are a professional athlete, recreational athlete, or elderly, we are dedicated to reach nothing less than your optimal health. CLINIC HOURS Our day is divided into office hours, adjustment hours and assessment hours. Assessment hours include: consultations, assessments and report of findings to patients. Staff can be reached by telephone only during the office hours. Consultations, assessments and reports should be scheduled during assessment hours only. Please ask staff for a copy of our hours. APPOINTMENT SCHEDULING & MISSED APPOINTMENTS Your practitioner has designed a specific course of action to allow proper care to achieve your optimal health. We will work with you to construct a calendar of dates and times to save you time on each visit. If an appointment must be changed, 24 hour notice is essential. To maintain the pace of correction, all missed appointments should be rescheduled later on the same day or within 24 hours. Please let our front desk know and changes will be made accordingly. FINANCIAL AGREEMENTS It is your payment that allows us to continue providing high levels of professional care, maintain our facility, and attend further continuing education and to compensate staff. If for any reason, you cannot keep your financial agreement, please inform us immediately to prevent any misunderstanding. If you have the desire to receive care in our office, we will make every attempt to make affordable arrangements. INTERRUPTION OF CARE In the unlikely event it becomes necessary to discontinue your care for any reason; any outstanding balance is due and payable immediately. If you have chosen to invest by means of advanced payment, any remaining credit will be returned after calculating the difference in the total of the regular fee for service multiplied by the number of services rendered. Remember, if you have the desire to receive care in our office, we will make every attempt to make affordable arrangements. OSTEOPATHIC EXCELLENCE Occasionally, our practitioners will be attending advanced training to enhance their ability to provide you with the highest quality of care. We will be building your schedule around those times or have a locum doctor/practitioner brought into the practice to continue care without interruption. REFERRALS The successes of our office and the health of your loved ones greatly depend on your referrals. We thank you in advance for your referrals. Signature Witness Date Date

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