What ADA Title III and WCAG 2.2 Actually Require from Your Chiropractic Website

Important note: This is educational content about accessibility regulations, not legal advice. Consult with an ADA compliance attorney for guidance specific to your practice.

ADA Title III requires places of public accommodation to provide equal access to goods and services. Chiropractic offices fall under this definition as healthcare providers. The legal question that's evolved over the past decade: do websites count as extensions of physical locations?

Courts have increasingly said yes. The Department of Justice has consistently taken the position that websites of public accommodations must be accessible, though formal rulemaking has stalled repeatedly. What matters for your practice: the absence of specific federal web regulations hasn't stopped lawsuits or DOJ enforcement actions.

The practical standard most courts and regulators reference is WCAG 2.2 Level AA — the Web Content Accessibility Guidelines published by the W3C. This isn't law itself, but it's become the benchmark for what "accessible" means in legal proceedings.

For chiropractic practices specifically, this affects:

• Online appointment scheduling systems
• New patient intake forms
• Treatment explanation videos and animations
• Patient portal login and navigation
• Contact forms and office information pages

State laws add another layer. California's Unruh Act, for example, incorporates ADA violations as automatic Unruh violations — with statutory damages of $4,000 per violation. Other states have varying accessibility requirements. Verify current rules with an attorney familiar with your state's specific accessibility laws.

WCAG organizes accessibility into four principles: Perceivable, Operable, Understandable, and Robust. Here's how each applies to common chiropractic website features:

Appointment Booking Forms

Perceivable: Form labels must be programmatically associated with input fields — not just visually positioned nearby. Error messages need to identify the specific field and describe the problem.

Operable: Every form element must be reachable and usable via keyboard alone. Date pickers are common failure points — many calendar widgets trap keyboard focus or lack keyboard navigation entirely.

Understandable: Required fields must be clearly indicated (not just with color). Instructions should appear before users encounter input fields, not after.

Treatment and Adjustment Videos

Captions: All video content needs synchronized captions. Auto-generated captions from YouTube or Vimeo are a starting point but typically require editing for accuracy — especially for medical terminology like "subluxation" or "spinal manipulation."

Audio descriptions: Videos demonstrating adjustments or exercises where visual information isn't conveyed through dialogue need audio descriptions explaining what's happening on screen.

Images and Graphics

Spinal diagrams, before/after posture images, and infographics all require meaningful alt text. "spine.jpg" or "image_001" fails accessibility requirements. Alt text should convey the information the image communicates: "Diagram showing cervical vertebrae C1-C7 with highlighted areas of common subluxation."

Complex images like anatomical charts may need extended descriptions beyond what fits in an alt attribute.

Patient portals sit at the intersection of two compliance requirements. ADA demands accessibility; HIPAA demands security. These aren't mutually exclusive, but they require careful implementation.

Common Portal Accessibility Failures

CAPTCHA barriers: Visual-only CAPTCHAs exclude users with vision impairments. Audio alternatives help but aren't perfect. Consider invisible CAPTCHA services or honeypot fields that don't create user-facing barriers.

Session timeouts: WCAG requires users be warned before timeouts and given options to extend sessions. Many portal systems time out for security reasons but don't provide accessible warnings. For HIPAA purposes, you need reasonable timeouts; for ADA purposes, users need accessible notification.

Document accessibility: Patient forms, treatment summaries, and educational materials distributed through portals must themselves be accessible. PDFs require specific accessibility features — tagged structure, proper reading order, form field accessibility. Many practices upload scanned documents that are completely inaccessible.

Third-Party Portal Vendors

If you use a third-party patient portal (ChiroTouch, Jane App, or similar), accessibility is still your responsibility to patients. When evaluating or renegotiating with vendors:

• Request their VPAT (Voluntary Product Accessibility Template) documenting WCAG conformance
• Ask about their accessibility testing methodology
• Include accessibility requirements in your contract
• Test the portal yourself with keyboard-only navigation

Vendor claims of "ADA compliance" are often overstated. Independent testing provides more reliable information than marketing materials.

Based on accessibility patterns we've observed across healthcare websites, these failures appear frequently on chiropractic sites:

Color Contrast Issues

Many chiropractic websites use light green or blue color schemes that fail WCAG contrast requirements. Text must have a contrast ratio of at least 4.5:1 against its background (3:1 for large text). Test your color combinations with a contrast checker tool — WebAIM's contrast checker is free and reliable.

Missing Skip Navigation

Users relying on screen readers or keyboard navigation need a way to skip repetitive navigation menus. A "Skip to main content" link should be the first focusable element on every page.

Auto-Playing Content

Testimonial carousels, background videos, and auto-advancing sliders create barriers for users with vestibular disorders and make screen reader navigation confusing. If content moves automatically, users must be able to pause, stop, or hide it.

Form Validation Problems

Inline validation that only uses color to indicate errors excludes colorblind users. Error messages must be announced to screen readers and provide specific guidance: "Email address is invalid" not just a red border.

What About Accessibility Overlay Widgets?

Widgets that promise "one-line ADA compliance" (AccessiBe, UserWay, and similar) have been widely criticized by accessibility professionals and disability advocates. These overlays:

• Don't fix underlying code problems — they attempt to paper over them
• Often interfere with assistive technology users already employ
• Have not prevented lawsuits — practices using them have still been sued
• Create false confidence that delays actual remediation

Fix the actual accessibility issues rather than relying on overlay services.

Addressing accessibility isn't a one-time project — it's an ongoing process. Here's a practical approach:

Initial Assessment

Automated scanning catches obvious issues: missing alt text, contrast failures, empty links, missing form labels. Tools like WAVE, axe DevTools, or Lighthouse provide starting points. However, automated tools catch only an estimated 30-40% of accessibility issues.

Manual testing is essential. Navigate your entire website using only a keyboard. Try completing appointment booking without a mouse. Test with a screen reader (NVDA is free for Windows; VoiceOver is built into Mac).

Prioritization

Not all issues carry equal weight. Prioritize by:

1. Blockers: Issues that completely prevent task completion (inaccessible appointment forms, keyboard traps)
2. Critical path: Issues affecting the main patient journey
3. Compliance visibility: Issues likely to be flagged in legal complaints
4. Quick fixes: Simple issues with disproportionate impact (alt text, contrast)

Remediation Timeline

For most chiropractic websites, meaningful accessibility improvements take:

• Quick fixes (alt text, contrast, link text): 1-2 weeks
• Form remediation: 2-4 weeks depending on complexity
• Video captioning and descriptions: Varies by content volume
• Third-party integration issues: Dependent on vendor cooperation

Document your remediation efforts. If a complaint arises, demonstrating good-faith progress toward accessibility matters.

Ongoing Maintenance

New content can introduce new accessibility issues. Establish processes for:

• Checking alt text when adding images
• Captioning new video content
• Testing new features before launch
• Annual comprehensive accessibility audits

Accessibility improvements often provide SEO benefits — not because Google explicitly rewards accessibility, but because many accessibility best practices align with search engine requirements.

Overlapping Technical Factors

Semantic HTML structure: Proper heading hierarchy (H1 → H2 → H3) helps both screen readers and search engines understand content structure. Many chiropractic websites use headings for visual styling rather than document structure, hurting both accessibility and SEO.

Image alt text: Descriptive alt text provides context for screen reader users and helps Google understand image content. Image search traffic and accessibility both improve with meaningful alt text.

Video captions and transcripts: Captions make video content accessible. Transcripts provide indexable text content for search engines. A detailed transcript of a spinal adjustment demonstration video creates SEO value while meeting accessibility requirements.

Page speed: Core Web Vitals affect both user experience for people with disabilities and search rankings. Slow-loading content particularly impacts users relying on assistive technology.

Mobile Accessibility

Touch target size requirements in WCAG (minimum 44x44 CSS pixels) align with mobile usability best practices Google emphasizes. Buttons too small to tap on mobile are also too small to click reliably for users with motor impairments.

Addressing accessibility systematically improves the technical foundation your SEO efforts build upon. Practices looking for accessible and optimized chiropractic practice websites benefit from addressing both areas together rather than treating them as separate projects.

For connection to other compliance requirements, see our guide on HIPAA compliance for chiropractic websites — patient data handling and accessibility often overlap in intake form design.