| Wendy Vere MA Vet MB MRCVS Veterinary Acupuncturist University of Guangzhou PRC 1986 |
| VETERINARY SURGEONS CONSENT FORM |
|
Date: To:
Canine/Feline/Avian/Bovine Acupuncture Assessment Your client ............................................................................................ has requested that I assess ................................................................... to see if he/she would benefit from an acupuncture treatment. The primary assessment takes at least an hour and involves a full examination including discussion of diet, current therapies, lifestyle and habits. Any underlying imbalances or conditions will be noted and treatment recommended, including, if appropriate, herbal remedies and traditional chinese medicine therapy. Please could you indicate whether you are happy for me to do this either by telephoning or by signing and returning this form via fax. I would be most appreciative if you could also forward any relevant case history, including current therapies. Please tick the box below if you would like a copy of the acupuncture assessment. Thank you
current therapies enclosed case history enclosed copy of assessment requested
signed: date: |
|
Moor
Farm, Morchard Bishop, Crediton, Devon EX17 6RX |