Veterinary Consent.

If your horse or dog has any current injuries or ongoing conditions, veterinary consent is required in accordance with the Veterinary Surgeons Act (1966), Exemptions Order Act (2015), and Chapter 19 of the supporting guidance to the Code of Professional Conduct. Please ask your vet to fill in this form in advance of the first session, Eden will also contact them directly for more information.

Any concerns relating to gaining consent please contact Eden directly.

Name

First Name

Last Name

Phone

(###)

###

####

Practice Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Patient name

and owner's surname

Relevant Medical History

Please include any diagnosed conditions or veterinary interventions that may be contraindicated with physiotherapy treatment

Please check if consent is given

I, the treating veterinary surgeon of the named animal above, give consent for the animal to receive physiotherapy from Eden Grace Veterinary Physiotherapy

Treatment reports

I would like to receive treatment reports following physiotherapy session;

I would not like to receive reports unless regression seen

After the initial session, and hereafter only if regression is seen

After every physiotherapy session

Preferred Method of Contact

Phone call

Text message