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Chiropractic Adjustment Release Form

Owner Name

First Last

Animal's Name(Required)

Animal's Breed(Required)

Animal's Age(Required)

Date(Required)

Please read and sign below

Fredericksburg Equine and Small Animal Veterinary Services offers chiropractic care in both our equine and small animal patients. Chiropractic care is holistic medicine and considered an alternative therapy by the Texas State Board of Medical Examiners. Before a chiropractic exam or adjustment is performed, by law you must acknowledge your understanding that chiropractic care is alternative medicine. I, Owner First Name Owner Last Name, understand chiropractic care is not intended to replace traditional veterinary care, but is considered an alternative therapy in Texas by the Texas State Board of Veterinary Medical Examiners. It is meant to be used in conjunction with traditional veterinary care. I understand the risks associated with chiropractic adjustments and that there is no guarantee of outcome for chiropractic adjustments. As the owner or authorized caretaker of the animal listed below, I hereby authorize Fredericksburg Equine and Small Animal Veterinary Services's veterinarians to adjust the animal listed below.(Required)

Phone

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Chiropractic Adjustment Release Form