Hello and welcome to Dallas Sports Academy. Please take the time to read our policies. If you have any questions please do not hesitate to ask. We look forward to working together to help you regain, maintain, and reach optimal health.

 

APPOINTMENTS 

Your appointment time is reserved for only you.  Our practice DOES NOT double book appointments.  24 hours notice is required should you need to cancel an appointment. You will be charged the full fee of your office visit should you fail to give 24 hours notice.  It is important that you be on time for your appointment.  If you are late, we will make every effort to see you, but it may not always be possible.  Your will still be responsible for your appointment fee if you are late.

 

PAYMENT POLICY
1. Payment is due at the time services are rendered. We accept cash, Visa/MasterCard, or a personal check.

2. A $30 reprocessing fee will be charged to your account should any personal check fail to clear.

 

TEXT AND EMAIL CONSENT

I do hereby authorize Dallas Sports Academy, Steven M. Horwitz, D.C. to communicate with me via text and email at the phone/text number and email address I have provided on my intake forms

 

This office transmits patient protected health information electronically.

 

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INFORMED CONSENT FOR CHIROPRACTIC TREATMENT

 

To the Patient: Please read this entire document prior to your visit. It is important that you understand the information contained in this document. Please ask questions during your first visit if there is anything that is unclear.  This information is not meant to scare or alarm you; it is simply an effort to make you better informed so you may give or refuse to give your consent to treatment.

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Spinal Manipulation or “an adjustment:”

The primary treatment used by a Doctor of Chiropractic (DC) or chiropractor is spinal manipulation. Spinal manipulation is frequently referred to as “an adjustment.” I may apply an adjustment or multiple adjustments to different joints to treat you. I may apply a mechanical instrument to your body in such a way as to move your joints. Either may cause an audible "pop" or "click," much as you have experienced when you "crack" your knuckles. You may feel a sense of movement. You may feel a bit sore, stiff, or fatigued after an adjustment. This is normal. However, if you feel increased pain, sharp pain, or any other abnormal sensations, contact me immediately.

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Muscle and Myofascial Therapies:

I use hands on and instrument assisted muscle and myofascial therapies. Hands on muscle therapy can be a bit painful. The goal is to increase blood flow and relax the muscles. Instrument assisted therapy like Graston Technique may also be painful and may even leave bruising. This is also normal and varies greatly from patient to patient. I will discuss these with you prior to treatment.

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Exercise Therapy and Posture:

I will review posture, ergonomics, and give you home exercises to perform. These are all a very important part of your care. The exercises may make you sore and again, this is normal. If any of them cause you significant pain, stop the exercise and contact me.

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Risks

As with any healthcare procedure, there are certain complications which may arise during chiropractic manipulation. Stroke and /or arterial dissection caused by chiropractic manipulation of the neck has been the subject of ongoing medical research and debate. The most current research on the topic is inconclusive as to a specific incident of this complication occurring. If there is a causal relationship at all it is extremely rare and remote. This 2021 paper states, “cervical manipulation has been estimated to have a complication rate of 5-10 per 10 million spinal manipulations.” Unfortunately, there is no recognized screening procedure to identify patients with neck pain who are at risk of arterial stroke.

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Additional complications include but are not limited to: fractures, disc injuries, dislocations, joint injury, muscle strains. Here is a recent paper discussing the efficacy of spinal manipulation and spine care. This 2021 paper states, “Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain.“

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Here is a 2019 paper discussing spinal manipulation and lower back care.

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Possible Contraindications to spinal manipulation include, but are not limited to:

*** If you have any of these it is your responsibility to inform me!

• Active or prior history of cancer

• Dislocations, fractures, or joint instability (like Ehlers-Danlos Syndrome)

• Arthritis of any type

• Bone weakening disorders like osteoporosis or infection

• Bleeding disorders

• Stroke

• Head or Brain Injury (Concussion)

• Neurological disorder

• Please see this document and this document for more information.

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I ask you to be a partner in your care and keep an open mind and open dialogue throughout your treatment program. Thank you for trusting me with your care.