| Wendy Vere MA Vet MB MRCVS Veterinary Acupuncturist University of Guangzhou PRC 1986 |
| VETERINARY SURGEONS CONSENT FORM |
|
Date: To:
Equine Acupuncture Assessment Your client ............................................................................................ has requested that I assess ................................................................... to see if he/she would benefit from an acupuncture treatment. The primary assessment involves a full examination including trot-up, assessment of saddle-fit and balance, foot balance, dental examination and assessment of the temporomandibular joint area for pain. Any underlying imbalances or conditions will be noted and treatment recommended. 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 |