Therapy-Questionnaire

Please take your time to carefully fill out the medical history form. It is a very important basis for your first treatment in our practice. If you do not wish to provide certain personal information in writing, you are free to do so. Your information will of course be treated confidentially and is subject to medical confidentiality.
Thank you very much.
(Fields marked with * are required)

Your current complaints

Körper

right

left

right

No complaints
Extreme complaints
No complaints
Extreme complaints

Your health background

Your daily habits

Conclusion



Fee agreement * (less information)

Cost of Treatment (as of 01.09.2022)

First treatment/Consultation
(30min): 100,00 Euro
(40min): 120,00 Euro
(50min): 140,00 Euro
Follow up treatments
(20min): 80,00 Euro
(30min): 100,00 Euro
(40min): 120,00 Euro
(50min): 140,00 Euro
(60min): 160,00 Euro
Please inform yourself if you might be reimbursed by your health insurance for chiropractic care. Usually the insurance will not cover the cost of treatment in this practice.
If you have to cancel an appointment please do within 24hours. For cancellations later than that or no-shows we will invoice half of the treatment cost of the missed appointment.


Data Protection * (more information)

Riskinformation / Risk disclosure * (less information)

The duty of care and education requires us to inform every patient about possible risks.

Treatment risks:
Performed by a qualified chiropractor, chiropractic offers a relatively low-risk treatment option for diseases of biomechanical origin.
There are no known risks associated with chiropractic correct treatment of joints in the arms and legs. The chiropractic treatment of the lumbar and thoracic spine is also very low risk. Only in 1:100,000 cases could occur a nerve damage.
Studies show that the risk of injury/damage to the cervical vertebral artery (Ateria vertebralis) is even lower when the cervical spine is chiropractically adjusted. A stroke can only occur in 0.64 out of 1,000,000 cases. However, it should be noted that in patients with pre-damaged blood vessels (risk factors: smoking, overweight, diabetes etc.) normal everyday behaviour, such as looking over the shoulder while driving a car, could also lead to such a complication.
Treatment reactions:
After the treatment, pain like delayed onset of muscle soreness might occur sometimes within the first 48 hours. Usually these disappear quickly when the affected areas are cooled. Temporary tiredness and/or headaches may also occur. A certain feeling of instability may also occur in the treated area for some time. If you need further information, please contact your treating chiropractor.


Knowledge and conscience Headline *