Leslie R. Trimble D.C., C.A.C.

Chiropractic Physician & Certified in Animal Chiropractic

2400 West Schneidman Dr., Quincy, IL 62305
217.214.0591

Dear Dr. ___________________:

In accordance with Public Act 93-0281, please accept this as notification informing you of
clients seeking chiropractic care in conjunction with traditional veterinary services. The
following client has requested a veterinary referral for the following animals:

Client: ________________________________ Animal(s): _____________________

_____________________
_____________________

Dr. Leslie R. Trimble is certified by the American Veterinary Chiropractic Association

(www.animalchiropractic.org). She received her postgraduate animal chiropractic training
at Parker Chiropractic College in Dallas, Texas.

I, _______________________________ have requested chiropractic care from Dr.

Leslie R. Trimble D.C., C.A.C. for the above mentioned animal(s) with the understanding
that she is not a veterinarian and therefore cannot provide veterinary care.

______________________________________________ ___________________
Client Signature Date

To Whom It May Concern:

I acknowledge that the above mentioned client wants their animal to be seen by Dr. Leslie
Trimble. If more information is needed on the above, I can request it from Dr. Trimble.

_______________________________________________ __________________
Signature of Veterinarian Date

Thank you for your time. Please mail or email form to: drlesliedc@yahoo.com or at the
above address. Any questions, please do not hesitate to call 217.214.0591.