Intake Forms for all Chiropractic Patients

Chiropractic Examination and Treatment Consent Form:

I attest that I am the owner of the animal described in this intake form, or an authorized agent, 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 remains intact. The result of this can additionally cause alteration of nerve function and interference to the transmission of nerve impulses, resulting in a lessening of the animal’s innate ability to express its maximum health potential).

Since there are many variables, it is difficult to predict the duration and frequency required for the recommended chiropractic procedures. It’s not uncommon for the response to animal chiropractic to be phenomenal. Most often, there is a more gradual but quite satisfactory response. Rarely, the results are less than expected, although there’s always that potential. Two or more similar conditions may respond differently to the same chiropractic care and certain animals/breeds are predisposed to unfavorable health conditions and often respond unpredictably (or more commonly, less favorably) to chiropractic care. The fact is, the science of chiropractic and medicine may never be so exact as to provide definitive answers to all problems. Both have made great strides in alleviating pain and controlling disease.

An owner of an animal bringing the animal in to the doctor of chiropractic or the doctor making house/barn calls, gives the doctor permission and authority to care for the patient in accordance with the chiropractic tests, diagnosis, analysis and procedures. The chiropractic adjustment or other clinical procedures are usually beneficial and seldom cause any problems. In rare cases, underlying physical defects, deformities or pathologies, even certain health-challenged animals/breeds may render the patient susceptible to injury. 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.

Chiropractic care is proven to be one of the safest and most effective forms of healthcare available.

Dr. Stephanie B. Parent, D.C., ACCC/AVCA is a Doctor of Chiropractic, licensed in the care of humans and animals through the state of Colorado, and is certified in Animal Chiropractic by the Animal Chiropractic Certification Commission (ACCC) of the American Veterinary Chiropractic Association (AVCA). Additionally, she has received specialized training specific to Animal Chiropractic, and is therefore qualified to perform animal chiropractic services.

Dr. Stephanie B. Parent, D.C., ACCC/AVCA is NOT a veterinarian, and cannot take responsibility for the primary care of my animal. According to Colorado laws for animal chiropractic, the treating veterinarian is required to be present during the treatment for all animals except equid and canine.

Chiropractic care IS NOT intended to replace appropriate veterinary care, but 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, injecting medications, laser treatments, taping, recommending supplements or replacing traditional veterinary care.

I realize there can be no guarantee as to the nature of my pets condition or the outcome of any procedure, and that the services are to only provide relief from those which are within the scope of animal chiropractic, as defined above.

I hereby authorize Dr. Stephanie B. Parent, D.C., ACCC/AVCA to adjust my animal with Animal Chiropractic. I certify that my animal has had regular veterinary care.