Consent to Care


I hereby request and consent to receiving spinal care, including wellness education in this office by a chiropractor(s) who provides Network Spinal Analysis (NSA) Care, a low force approach which has unique outcomes and clinical results. This practitioner(s) chooses to practice NSA, as he/she is professionally and personally confident in regard to the safety and effectiveness of this form of care.

This office provides care in accordance with the Council on Chiropractic Practice Guidelines and the Canon of Ethics of the Association for Network Care. My doctor(s) has been trained in traditional chiropractic care and certified in the procedures of Network Spinal Analysis Care.

The purpose of this consent form is to help me better understand the nature of the services offered in this office and our mutual responsibilities. This fosters a more effective relationship and avoids misunderstandings regarding expectations. Having well understood expectations is anticipated to promote a greater sense of safety and healing.

NSA does not attempt to manually, or by instrument, manipulate spinal fixations structurally (often associated with a snapping or popping sound), nor does it directly treat painful areas of the spine and body. Instead, by enhancing my body’s awareness of itself and specifically my spine, I understand I can develop new strategies for healing, adapting to stress, and experiencing wellness. These strategies promote spontaneous self-correction and self-regulation of spinal tension patterns and healing.

NSA consists of gentle touch contacts along the neck and back to achieve greater communication between the brain and body, and new sensory and motor strategies. NSA adopts an approach associated with somatic (body/spinal awareness) training. There is a body of research characterizing NSA care and documenting its unique and significant wellness benefits. I understand I may obtain copies of published research articles and/or abstracts in this office.

I am aware that I will be receiving gentle touch Network adjustments, also called entrainments. Assessments of my progress will include monitoring of my spine and body awareness, responsiveness to inner rhythms, tension, and ease patterns. At regular intervals, following commencement of care, re-assessments will be performed. These will include my personal perception of my wellness and my awareness of my spine and body-mind changes. My chiropractor(s) will report to me the improvement in my spinal and nervous system integrity and my ability to self-regulate tension and to re-organize my spine.

NSA is advanced through a series of levels of care. Each Level of Care involves the development of new and unique spontaneous spinal wave motions, other body movements, and oscillations. These waves, which are suggested to be associated with the greater spinal stability, the re-distribution of energy, and the transfer of internal information are also associated with greater wellness, improved quality of life, and in- creased life enjoyment.

I also understand that, in addition to NSA care and wellness education, my practitioner(s) may perform additional examinations or assessments and offer health/spinal care or advice that is consistent with my individual needs.

It has been explained to my satisfaction, and I understand that the care offered at this office is not a form of, or replacement for, the diagnosis or treatment of any symptom, disease, or malady. Instead, it is a form of wellness care and self-education that empowers my connection with my body-mind and develops new strategies for spinal and nervous system integrity and wellness. It develops new capacities in my body for the identification of, spontaneous release of, and redirection of tension, including those that are unique to NSA care.

It is common for people receiving NSA care to breathe more deeply and more fully, engaging the spine with their respiration, to spontaneously adapt postures that release or redistribute tension, to bust stress, and to experience more of their inner life energy. ,

I understand it is common to experience a wider range of motion and emotion during care. It is common, as care progresses, to find new options in the body and in life, which often lead to significant life changes. This form of care is NOT suggested for those individuals who wish to remove a symptom or condition without the occurrence of other fundamental changes in their lives. The care in this office often promotes significant changes in health choices, lifestyle, experience of the body-mind, emotion, and consciousness.

Rather than attempting to simply return me to my previous state minus a symptom, this practitioner instead chooses to help me achieve new levels of wellness and life potential that I may never have had before.

I have read, or have had read to me, the CONSENT TO RECEIVE NETWORK SPINAL ANALYSIS (NSA) CARE and understand that the care in this office is different from what many consumers may expect from chiropractors practicing manipulative therapy. I agree to receive care, which consists of or includes NSA care and wellness education. I understand that I am not passive in this process, but that I am an active participant in my care and in my healing.


Somato Respiratory Integration (SRI) Wellness Education Information and Notice of Informed Consent

Somato Respiratory integrationTM Wellness Education* is specifically designed to educate you to your body rhythms and inner wisdom through focused attention, gentle breath, motion and touch. As a consequence of such heightened awareness, you may have more resources to heal and advance through your Network Spinal Analysis Care.

Although you may have had instruction in other self-awareness, breathing, movement and meditation programs, please understand that SRI is different. Rather than attempting to “strengthen” a muscle group or body part, SRI strengthens your inner connection. With SRI you will experience having the “higher” brain focus its attention on a region and/or sensation that was formerly repressed, discarded, denied or desensitized. This work allows for greater connection between your higher brain and your body, fostering the ability to focus your attention on your body and develop internally customized structural choices for your body and for your life.

Many of our crises occur when we become “unconscious” of our body, or a region of our body, and take it for granted, or we lose an important element of the interface between body and mind. Symptoms of all types ask us to pay attention, and that is often that last thing people are looking to do. Symptoms force us to be in touch with our body, stop our usual routine, do things differently, breath differently and even at times express emotion or make “foreign” sounds. There is healing in this and wisdom to be gained. It is hoped that with SRI care you will not need to have a severe crisis to help you pay better attention to yourself, and with the addition of NSA Care you will have the available tools to do this. It is easier to make frequent small reassessments and adjustments in life than to have life force you to make a sudden large change. Our intent is to help you develop the somatic habit of consistent spontaneous reassessments, self-adjustments, and corrections of your body, its structure, and its relationship to your life. In this way you can be more flexible and adaptable to the demands, suggestions, and encouragement of life.

Although many methods for healing may use varied breathing techniques, body motion, emotional “release”, or self-touch to produce and altered experience, few produce as powerful a total body response and give you the practical “take home” skills that SRI does. Practice Members in NSA care commonly remark that NSA is the most powerful wellness and healing modality they have ever experienced. Many say the same about SRI as an empowering self-help and self-advancement tool. We offer you the benefits of the additive value of both systems.

The exercises of The 12 Stages of Healing which produce Somato (body) Respiratory (breath) Integration will be taught in group/private sessions. These exercises will help you to experience your body more fully with safety and peace. As a home support program of self-care, they will also further your advancement in Network Care. It is our experience that these exercises allow you a positive and constructive tool that you can use to deepen the understanding, trust, and well-being of your body-mind.

In times of symptom crises, SRI will provide you with a method to redirect your body’s attention, release tension, and promote greater ease.

Your SRI Wellness Educator will not diagnose, treat, or offer advice on any disease or symptom. SRI Wellness Education is not specifically about your condition or symptom. It is about you and your available and developing resources.

It is common for self-awareness to heighten during the course of NSA care as well as during and after SRI sessions. Since you will be learning to pay attention to your body’s subtle cues, areas that were “disconnected” from your awareness will awaken their connection. You may experience physical sensations such as energy, vibration, heat or at times discomfort. You can discover where you store a resource of “chi” (life energy) for your use. You will learn to redirect your body-mind’s attention from a distressing circumstance of the moment to inner safety and peace.

During and after some SRI sessions you will likely also be aware of emotional shifts. Sensations may be subtle, or at times very intense, as one experiences greater depth in his/her range of the healing stages.

When utilizing these exercises during this program or after, if you are uncomfortable with your experience and/ or if fear or helplessness occur, slow your breathing rhythm and/or use less breath. Focus on directing movement into chest or abdomen. Remove your hands from the area of distress and redirect your attention to an area of comfort, or peace.

I have read the above Notice of Intent and agree to participate in Somato Respiratory Integration Wellness Education. I consent to receive SRI Wellness Education, including learning the SRI exercises. I understand that during these classes I will be touching my body, breathing, and at times verbalizing my experience of my body. I understand that SRI exercises are not a replacement for any form of medical treatment.

I consent to allow my SRI Wellness Educator to touch me for the purpose of assisting me in learning and refining my experience of these exercises. I consent to allow my NSA practitioner to release information from my personal and clinical history to my SRI Wellness Educator. I also give consent to my SRI Wellness Educator to share personal and clinical information with my NSA practitioner. I agree to allow such communication on an ongoing basis so that the exercises and skills I am to learn can be fine-tuned to compliment my circumstances and current NSA Level of Care.

Copyright, 2002, Dr. Donald Epstein