Informed Consent Agreement

Your symptoms are serious to you and my goal is to assist you in finding any underlying and reversible causes of those symptoms. Before we begin, it is important that you understand what an osteopathic manual medicine approach entails so that you can anticipate and feel comfortable as we proceed.

Osteopathic manual medicine involves a whole body approach. It is not limited to examining the area of your body where you feel the bulk of your discomfort. It seeks to find tension in your body that influences the area in question. If you have a serious structural problem (e.g. torn ligament, broken bone, loss of cartilage, invasive cancer) your diagnosis can be established by a traditional medical approach. Osteopathic evaluation and treatment approaches can diminish symptoms and optimize function to a degree, but those problems are better treated via the traditional medical care system.

The practice is known as “manual medicine,” as this means that you will be treated with my hands. My hands are my best diagnostic tool and are also my best treatment tool. You will be touched as I feel for regions of tension in your body. This process is known as myofascial “listening.” Both diagnosis and any treatment will involve hands-on pressure and touch. This contact may be at the locale of your restrictions or, in the case of a deep seated visceral restriction in the thorax or a deep restriction of the nervous system connective tissue, the contact will be on external structures that attach on their internal surface to the deep structure in question.

Contact points may include the superior surface of the pubic bone, the anterior chest (breast bone and inner ribs), structures deep in the abdomen, arteries and ligaments in the groin, the bones of the pelvis including the bones you sit on. Other areas that might be treated include the skull, face and inner mouth, the spine, other bones of the pelvis, the posterior rib cage, anterior neck and the hard and soft tissue structures of the arms and legs. I do not do genital evaluation or treatment.

My intention is to find as many sources of physical tension in your body as possible and to restore your body to its normal balance. This balance optimizes your body’s ability to physically heal and correct itself, which then allows reduction of symptoms and improvement of function and performance.

You are welcome to have any companion (friend, spouse, another caregiver) present with you at all times during your evaluation and treatment. If I feel a need to speak with you in private due to confidentiality concerns, I will ask for that privilege should you have a companion with you.

There are very few professional circumstances in society in which touch is used this extensively. Treatment is sometimes uncomfortable, physically or emotionally. You are in control. You may tell me to stop at any time. You may ask for more in-depth discussion of what I am finding and treating, and why I feel a specific treatment is necessary. This is your body, your pain or discomfort: You are in control. I am here to help you to the best of my abilities.

We will provide a printed version of this agreement at your first visit for you to sign.

Madison Manual Medicine
2940 Chapel Valley Rd #1b FitchburgWI53711 USA 
 • 608-512-7177
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