Acupuncture History Form

I understand that Alma Vet Connection offers both traditional/conventional veterinary care AND alternative care modalities. These modalities may include:

• Acupuncture
• Herbal Medications
• Ozone Therapy
• Tui na Massage Techniques
• Food Therapy
• Homeopathic Remedies
• Veterinary Orthopedic Manipulation
• Ultraviolet Blood Irradiation
• Pulsed Electro Magnetic Frequencies

I understand that the safety and/or effectiveness of some alternative modalities may not be well-established and/or are deemed “experimental” according to the American Veterinary Medical Association and/or the U.S. Food and Drug Administration. I also understand that, although rare, the potential for adverse reactions to some of these treatments exists.

I agree that Alma Vet Connection has explained, in sufficient detail to understand and with the opportunity to ask questions, the alternative treatments above so that I can make an educated decision on their use for my pet. I also realize that I have the option to do nothing if I so choose.

I acknowledge that, due to manufacturer supply limitations and FDA regulations, it is a common veterinary practice that some medications prescribed or administered may be compounded or used “off label.”

I accept ALL financial responsibility and understand that all professional fees are due at the time of services. I understand that additional charges may apply when applicable, such as a missed appointment fee or an emergency work-in fee.

In the event of an emergency, if I am not present, I understand that every attempt will be made to contact me. I hereby give permission for any reasonable treatments needed to stabilize my pet to be done or given in the event of said emergency, unless specifically discussed otherwise, such as during admission to the hospital for anesthesia/surgery.