Weight loss, pain or any dis-ease for that matter require a complete and in depth analysis. The consent below is allowing me to assess what is best for you whether Chiropractic, Pulse center PEMF, Nutrition or any other services. Dr. Paul's goal is to provide you with adjunctive and supportive care for your health condition. We do not claim to treat or cure any disease or medical diagnosis.

Our office offers some services that are not covered by insurance. These services are considered experimental and may not be billed to your insurance. Dr. Paul will review all services that are considered covered services and those that are not. Nutritional support may be offered for your case. Nutritional supplements are not FDA regulated and have not been proven to cure or treat any disease or illness.

Our services are not a replacement for your medical treatment. We choose to work alongside your medical provider as this serves you in the most effective manner possible.

Dr. Paul will never give advice on the use of your medications. Medications must be managed by your medical doctor. You must work with a medical doctor for the management of any medications you take now or in the future.

I completely understand that there are no guarantees of help, correction, relief, or cure, written, spoken or implied.  I understand that this clinic does NOT treat any disease or any medical diagnosis.

I am making a sane and conscious decision to seek advice as per the above understood terms for either myself and/or my dependents.  In doing so, I agree to the above terms and acknowledge this with my signature below:

If agreed upon between Body Intelligent Center and myself, I hereby request and consent to the performance of chiropractic adjustments and any other chiropractic procedures, including examination test and physio therapy techniques, on me (or on the patient named below for which I am legally responsible) which are recommended by the Body Intelligent Center.

I understand and am informed that, as in the practice of medicine, in the practice of chiropractic there are some risks to treatment including, but not limited to, fractures, disc injuries, strokes, dislocations and sprains. It is not reasonable to expect the doctor to be able to anticipate and explain all risks and complications of a given procedure on any particular visit, and I wish to rely on the doctor to exercise judgment during the course of the procedure which the doctor feels at the time, based upon the facts then known, is in my best interests.

I have read, or have had read to me, the above explanation of the treatment options above.  By signing below I state that I have weighed the risks involved in undergoing treatment and have myself decided that it is in my best interest to undergo the chiropractic treatment recommended.  Having been informed of the risks, I hereby give my consent to that treatment. I intend this consent form to cover the entire course of treatment or my present condition and for any future condition(s) for which I seek treatment.

Agreement to arbitrate disputes
I specifically agree that all claims against any of the Releases that I may have or choose to make shall only be submitted to binding arbitration under the rules of the Arbitration Act or similar statute of my province of residence, and I waive any rights to pursue any claims or causes of action in any court of law.

I have read and understand the above.

Office Visit Fees

Chiropractic/Acupressure:  $147

Support for Cancer/Autoimmune/Hashimotos/Other Diagnoses that were made my your Medical Doctor: 

$197 to $297 for the First Visit depending on the severity of the condition.     

Succeeding visits:

$47.00-$197.00  

Other Charges:

Supplements or lab tests if necessary are not included.

Return of supplement Policy:  Subject to 25% restocking fee. Opened bottles are not returnable as well as Perishable items that need to be refrigerated.

Missed Appointment Charge (no 24 hour advance notice): $75

Bounced Check Fee (per incident)*: $35

Copies of charts requested by 3rd party: $20

*If there are two incidents of bounced checks, then future visits will require cash payment.

 Dr. Paul T. Kwik D.C.

Body Intelligent Center
101 S. Kraemer Blvd., Suite 111
Placentia, CA  92870
714-528-2219