CHIROPRACTIC EXAMINATION & TREATMENT CONSENT FORM AND CLIENT VERIFICATION OF CONCURRENT TRADITIONAL VETERINARY CARE
I, owner of the animal described above, understand and authorize the following:
1. Dr. Desiree Draws is a Doctor of Chiropractic. She has attended several hundred hours of post graduate education speciﬁc to animal chiropractic through the accredited school, Healing Oasis Wellness Center, and has been approved by the state of Colorado and the American Veterinary Chiropractic Association.
2. Dr. Desiree Draws is NOT a veterinarian, and cannot take responsibility for the primary care of my animal. Nor will she be diagnosing or treating any medical or veterinary conditions previously diagnosed or undiagnosed by a licensed veterinarian.
3. Chiropractic care is NOT intended to replace traditional veterinary care, but is considered a Complimentary Therapy, to be used concurrently and in conjunction with my veterinarian’s care.
4. Dr. Desiree Draws has explained to me the scope of chiropractic care, and described the procedures and techniques she will perform on my animal. I understand those procedures and acknowledge that they agree with the American Medical Association’s (AVMA) description of animal chiropractic as follows:
“Veterinary chiropractic is the examination, diagnosis, and treatment of non-human animals through manipulation and adjustments of speciﬁc joints. The term "veterinary chiropractic" should not be interpreted to include dispensing medication, performing surgery, injecting medications, recommending supplements, or replacing traditional veterinary care. While sufficient research exists documenting efficacy of chiropractic in humans, research in veterinary chiropractic is limited. Sufficient clinical and anecdotal evidence exists to indicate that veterinary chiropractic can be beneﬁcial. It is recommended that further research be conducted in veterinary chiropractic to evaluate efficacy, indications, and limitations. The assurance of education in veterinary chiropractic is central to the ability of the veterinary profession to provide this service. Veterinary chiropractic should be performed by licensed veterinarians; however, at this time, some areas of the country do not have an adequate supply of veterinarians educated in veterinary chiropractic. Therefore, it is recommended that, where the state's practice acts permit, licensed chiropractors educated in veterinary chiropractic be allowed to practice this modality under the supervision of, or referral by, a licensed veterinarian who is providing concurrent care.”
5. Dr. Desiree Draws has explained the risks involved with the animal chiropractic care to my satisfaction, and I realize that there can be no guarantee as to the nature of my animal’s condition, or the outcome of any procedure.
I hereby authorize Silver Lining Animal Chiropractic, and Dr. Desiree Draws to treat my animal with animal chiropractic.
I certify that I have been open and honest with Dr. Desiree Draws as to any and all other examinations, diagnostic tests, diagnoses, and treatments for my animal’s conditions. I have read this authorization form, understand it, and give my consent.