Request for Care / Referral Form
Pet/Patient's Gender: MaleFemale
The above client is seeking pet evaluation and chiropractic treatment by Las Vegas Animal Chiropractic. Treatment will be rendered by Dr. Sidney Carter, D.C. an American Veterinary Chiropractic Association trained and Nevada Board registered Chiropractor. As per NAC 638.830, you are not liable for the acts or omissions of the chiropractor who performs animal chiropractic and Dr. Carter carries his own malpractice insurance.
Please submit this completed form to us using the submit button below, or via email at LasVegasAnimalChiro@gmail.com. If you prefer to speak with us or text us we can be reached at 702-703-1866.
Dr. Carter will use this information to determine if your client is a chiropractic candidate.
Do you have any concerns regarding this client receiving chiropractic care? YesNo
Have X-rays been taken in the past year? YesNo If yes, please email the written report only to LasVegasAnimalChiro@gmail.com
Would you like to receive our treatment notes? YesNo
Would you like to opt out of receiving emails? YesNo
