I consent to allow the Danto Osteopathic Clinic to perform non-surgical spinal decompression using the Hill Decompression Table upon me.  I understand that non-surgical spinal decompression is a non-invasive therapy where I will be placed in a machine that is designed to create targeted negative pressure at specific levels within my back and spine. Additionally, due to the nature of my spine being within my body the negative pressure will be created within adjacent structures and tissues. 

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I understand that generally non-invasive spinal decompression is well-tolerated, but there may be some discomfort after the therapy. This discomfort may feel like an exacerbation of my pain. I understand that if I had pain or symptoms in my leg (for low back problems) or arm (for neck problems) then as the body heals and the leg or arm pain goes away, I may have pain in my back or neck and that this is considered part of a normal progression towards healing. I understand that walking and light stretching are recommended for the after the spinal decompression sessions and my body will be in a state adjusting to the effects of the decompression for at least 24-hours after the therapy.

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I understand that non-invasive spinal decompression is contraindicated with the following conditions, and I will communicate to my provider if I have any of them: Pregnancy, spinal Infection or inflammation (meningitis, arachnoiditis, etc.), or spinal cancer; severe spinal injury (cauda equina syndrome); Rheumatoid Arthritis; spinal, rib, or pelvic fracture; osteoporosis; abdominal disease (hemorrhoids, aortic aneurysm); uncontrolled hypertension; acute respiratory disease, and joint hypermobility.

I have the right to have a chaperone present when I am with my provider or any member of the staff.  A chaperone is required for any sensitive examination unless I decline in writing. If I am consenting on behalf of a child under 11 years of age, I may serve as the chaperone.

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I understand that a closed-circuit video recording will be made and maintained for 2-months after the visit. The visit is recorded for medicolegal reasons to protect myself and that of the clinicians and staff of Danto Osteopathic, LLC. I understand that I may ask for the camera to be covered during a visit or for any portion of the visit.

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I understand that I may refuse non-invasive spinal decompression. I have the right to discuss any treatment with my provider. I am encouraged to ask questions about my concerns. I also understand that it is important to communicate with the personnel at the Danto Osteopathic Clinic if something doesn’t feel correct to me during the spinal decompression therapy.

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I understand that non-invasive spinal decompression is not intended to be performed as a stand-alone procedure for my complaints/disease process. It is intended to be part of a comprehensive treatment program that involves pre and post decompression therapies, osteopathic manipulative treatment (OMT), home exercises with disc centralizing and core strengthening components, posture modification, and lifestyle modifications, which may include dietary modification, activities of daily living modification, nutritional support, and elimination of other factors that may be contributing the problems for which I am being treated.

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I understand that if additional testing or invasive procedures are needed, I will be asked to read and sign additional consent forms.

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I understand that this consent is valid until I revoke it in writing.