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WORK HOURS:

Monday - Friday 9am - 5pm

Sleaford, United Kingdom

OUR LOCATION

Veterinary Acupuncture and Pain Management

Veterinary Acupuncture and Pain Management Logo

To fill out the online Owner's Consent Form, please ensure all required fields are completed with accurate personal and pet information. Carefully review the terms and conditions, then electronically sign and submit the form to indicate your consent to the proposed treatment and agreement to the terms. Thank you for completing the form online.

Owner Consent for Pain Clinic / Acupuncture / Class 4 Laser / Herbal Referral

Owners Details:

Animals Details

Sex
Male
Female
Neutered
Yes
No
Insured
Yes
No

Vets Details:

Reason for referral:

Reason for referral

Terms & Conditions

⦁ Your animal must be registered with a veterinary practice local to you.

⦁ Your animal will not be seen without a referral from your primary care vet

⦁ Your animal must have been assessed recently by your vet prior to referral.

⦁ The referral should include a referral form, signed by the veterinary surgeon responsible for your pet, and a full patient history, including any diagnostic imaging / recent blood results

⦁ Your pet must remain under the care of the referring veterinary surgeon/practice or another primary care practice whilst under the care of Veterinary Acupuncture and Pain Management for chronic pain management and/or complementary therapies (laser / acupuncture / herbal medicine).

⦁ Your primary care vet should be the first point of call for anything other than that for which referral has been made.

⦁ Diagnostics / further investigations remain the responsibility of your first opinion vet and any relevant information should be shared with Veterinary Acupuncture and Pain Management so as not to compromise patient care.

⦁ Patients on long-term medication will be advised to have regular bloods tests and these will be directed back to your first opinion vet practice. The results should be shared with Veterinary Acupuncture and Pain Management at the earliest opportunity as a change in treatment may be required.

⦁ Any potential side effects of any treatment given / prescribed by Veterinary Acupuncture and Pain Management will be discussed in full at the time of the treatment and you will be instructed what to do should these occur.

⦁ Many of the medications used to manage chronic pain are not licensed for use in animals but are widely accepted as being safe and effective when used appropriately. You will be asked to sign an “off-licence” form when these drugs are prescribed for the first time by Veterinary Acupuncture and Pain Management and then annually, thereafter.

⦁ Should your pet experience a sudden deterioration in their symptoms, you should contact your primary care vet (or their dedicated out of hours service provider) as further investigations / quicker acting “rescue” analgesia / hospitalisation or euthanasia may be required.

⦁ Your primary care vet will be kept updated on any treatments prescribed / given by Veterinary Acupuncture and Pain Management and will be informed of any concerns that requires further investigation / intervention that is outside the remit of Veterinary Acupuncture and Pain Management

⦁ You must inform me, at the earliest opportunity, if there has been any changes in your pets health requiring veterinary intervention since your last appointment. This may affect any treatment given.

⦁ Legislation now requires that patients on controlled drugs (e.g tramadol and gabapentin) will only be prescribed a months treatment at a time and must have a physical examination prior to each prescription being issued.

⦁ Payment is expected in full within 7 days of the appointment via BACS, Cash, or Card.

⦁ Insurance – treatment is likely to be covered on your policy but please check with your insurance provider. As a small business I am unable to do direct claims. Payment must be made to me and then a claim submitted to your insurance company,

⦁ If you are unable to attend your appointment please inform Veterinary Acupuncture and Pain Management at the earliest opportunity to cancel. Failure to attend a scheduled appointment may result in a charge.

⦁ On being referred to Veterinary Acupuncture and Pain Management you are agreeing to the above terms.


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