Sidney Carter, D.C.

702-703-1866  |  www.lasvegasanimalchiro.com
Chiropractic Care for Large and Small Animals

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    YOUR CONTACT INFORMATION

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    ADDITIONAL ADDRESS

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    YOUR ANIMAL'S INFORMATION

    Neutered/Spayed*
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    YOUR VETERINARIAN'S INFORMATION

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    ADDITIONAL INFORMATION

    HOW CAN WE HELP? (Please be sure to include when any issues began and how your animal received the injury if applicable.)

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    ADDITIONAL COMMENTS

    ANIMAL CHIROPRACTIC CONSENT

    YES - I understand that Chiropractic Care IS NOT intended to replace traditional veterinary care, but is considered an alternative therapy to be used concurrently and in conjunction with my Veterinarian’s care.

    YES - I certify that my animal has had regular, traditional veterinary care, and no limitations, no restrictions or contra-indications for chiropractic care are placed upon the animal. The animal is now being treated by my list Veterinarian.

    YES - I understand that Dr. Carter will describe the procedures and explain, to my satisfaction, the purpose for performing them and the risks involved with them. I realize that there can be no guarantee as to the animal’s condition or the outcome of any procedures.

    YES - I certify that I will been open and honest with Dr. Carter as to any and all other examinations, diagnostic tests, diagnoses, and treatments for my animal’s condition.

    YES - I understand that multiple visits may be necessary to determine the proper course of treatment.

    YES - As the owner / guardian of the animal(s) described below, and being eighteen years of age or older, I hereby authorize Dr. Sidney Carter to treat my animal(s).

    Submission

    We will contact you as soon as possible during normal business hours.