• CHILD CASE HISTORY

  • Personal Data

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  • CAUSE

    The human body is designed to be healthy. The primary system in the body which coordinates health is the nervous system. The healthy function of every cell, every system, and every organ is dependent upon the integrity of the nervous system. The bones of the skull and vertebrae of the spine house and protect the central nervous system.

    From the birth process until the present, events have occurred in your child’s life which may have caused interference and damage to this delicate system. Physical, emotional, and chemical stresses common to our contemporary lifestyles can result in misalignment and damage to the spinal column. This interference is called the Vertebral Subluxation Complex.

    This form will help reveal the causes of Vertebral Subluxation which interfere with the optimal function of your nervous system and therefore impair your inborn health and wellbeing.

  • The Vertebral Subluxation Assessment

  • 2. Experts around the world agree: the birth process as we know it may cause extensive neurological trauma, damage, and even death to the infant.

  • 3. Repeated studies are now informing us that breastfeeding helps to develop strong and healthy immune, neurological and digestive systems.

  • 4. According to the National Safety Council, approximately 50% of infants have fallen onto their heads during their first years of life. Another study reveals 1/4 million children are injured on playgrounds annually.

  • I hereby authorize Lisa Lewis, D.C. and whomever she may designate as assistants to administer chiropractic adjustments and treatment to my minor son/daughter {name}.

    The patient information given is true and complete to the best of my knowledge.

    I understand that all services are to be paid in full at the time of the service unless other arrangements have been made and agreed upon in writing.

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