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Printable Bounce Back Consent Form

Printable Bounce Back Consent Form

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Published by Betsy Silver
Animal Chiropractic Treatment and Consent Form
Animal Chiropractic Treatment and Consent Form

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Published by: Betsy Silver on Aug 23, 2012
Copyright:Attribution Non-commercial

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03/15/2013

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Bounce Back Animal Chiropractic
Dr. Lauren Kadrich
1019 US 23 N. Alpena, MI 49707
Office: 989-356-9922 Cell: 989-255-2306
CHIROPRACTIC EXAMINATION & TREATMENT CONSENT FORM AND VERIFICATIONOF CONCURRENT TRADITIONAL VETERINARY CARE
I, _________________________________________________owner of the animal describedbelow, and being eighteen years of age or older, do understand, substantiate, and authorize thefollowing:1.
 
Dr. Lauren Kadrich is a Doctor of Chiropractic, licensed in the care of humans. She alsohas extensive training and education specific to Animal Chiropractic.2.
 
Dr. Lauren Kadrich
IS NOT
a veterinarian, and cannot take responsibility for the primarycare of my animal.3.
 
Chiropractic Care
IS NOT
intended to replace traditional veterinary care, but isconsidered a Complimentary Therapy, to be used concurrently and in conjunction withmy Veterinarian’s care.4.
 
I understand that there is minimal research supporting the clinical efficacy of AnimalChiropractic, and that some aspects of my animal’s care may be used in future researchdata.5.
 
Dr. Lauren Kadrich has explained to me the scope of her care, and described theprocedures she will perform on my animal. I understand that Dr. Lauren will check myanimal for subluxation complexes which affect the muscles, joints, and nervous system.I understand that Dr. Lauren will perform Chiropractic adjustments to correctsubluxation complexes that are found.6.
 
Dr. Lauren Kadrich has explained the risks involved with Animal Chiropractic care to mysatisfaction, and I realize that there can be no guarantee as to the nature of my animal’scondition or the outcome of any procedure.
I hereby authorize Dr. Lauren Kadrich to treat my animal with Animal Chiropractic. I certifythat my animal has had routine, traditional veterinary care, and my current veterinarian is :
 Veterinarian: _________________________________Phone: ___________________________Address: __________________________________________________________________ __________________________________________________________________

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