owner or agent of the animal listed, and being
eighteen years or older, do understand, substantiate, and authorize the following:
The purpose of chiropractic services is to promote natural health through the reduction of intervertebral joint restrictions (a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remain intact). The result of this can additionally cause alteration of nerve function and interference to the transmission of the nerve impulses, resulting in a lessening of the animal’s innate ability to express its maximum health potential. Like most health care procedures, chiropractic treatments carry with it some risks. Unlike many such procedures, the serious risks associated with chiropractic care are extremely rare. Similar conditions across patients may respond differently to the same chiropractic care. In rare cases, underlying physical defects, deformities or pathologies, even certain health-challenged animals/ breeds may render the patient susceptible to injury. Certain animals/ breeds, such as chondrodystrophic breeds, are predisposed to respond unpredictably or more commonly, less favorably to chiropractic care. It is the responsibility of the patient to make known, or to learn through health care procedures whatever their animal is suffering from: latent pathological defects, illnesses or deformities which would otherwise not come to the attention of the Doctor of Chiropractic. I hereby give my consent to the performance of diagnostic tests, procedures, and chiropractic treatment or massage to help manage my animal’s condition/s.
Chiropractic care is proven to be a safe and effective form of healthcare
• The provider/s treating and/or managing my pet’s chiropractic condition/s is/are a Doctor of Chiropractic, licensed in the care of humans. Additionally, they have received specialized training specific to Animal Chiropractic, is/are board certified by the IVCA, and is/are therefore qualified to perform animal chiropractic services.
• The provider managing my pet’s chiropractic condition is NOT a veterinarian and cannot take responsibility for the primary care of my animal.
• Chiropractic care IS NOT intended to replace appropriate veterinary care, it is intended to be used concurrently.
• I have read and understand the scope of the animal chiropractic care my pet will receive. I understand and acknowledge and agree with the College of Animal Chiropractors description of Animal Chiropractic as follows: “Animal Chiropractic is the examination, diagnosis, and treatment of non-human animals through manipulation and adjustments of specific joints and cranial sutures.” Animal Chiropractic DOES NOT include: dispensing of medications, performing surgery, prescribing medications, or replacing traditional veterinary care.
• I hereby authorize and give my consent to the performance of chiropractic tests, procedures, and chiropractic treatment and/or management of my pet’s chiropractic condition.
• I certify that my animal has had regular veterinary care, and has a current, good-standing relationship with a veterinarian.