Consent for Treatment

I am the owner or the agent for the owner of the animal,   Type Pet's Name   and I have the authority to execute this consent.

I hereby consent and authorize Dr. McElrath to perform the following procedures:

• The evaluation of my pet, which may include observation and measurements.
• Integrative medicine sessions which may include: acupuncture, electrical stimulation, spinal manipulation, injections, massage therapy, pulsed electromagnetic field therapy, activities (walking, trotting, lunging, stretching) and any other alternative therapies. I give Twin Willows Integrative permission to perform any and all of the foregoing procedures on my animal.
• To the best of my knowledge, my animal has no contagious diseases including kennel cough, intestinal parasites, skin or fungal infections for small animals and influenza, equine herpesvirus, strangles, or vesicular stomatitis in equids. 
• I understand that it is my responsibility to inform Dr. McElrath of any and all concurrent medical conditions suffered by my animals. This includes disclosing any medications and supplements my animal is currently taking.
• Twin Willows Integrative may use photographs and/or videos of my animal to assist with treatment, education, measurement of progress/outcomes, as well as for marketing purposes. I authorize the taking of photos and videos and concurrent use. I will not seek any reimbursement or compensation for the use of photographs and/or videos of my animals from Twin Willows Integrative.
• I understand that on occasion, Twin Willows Integrative may host visitors, volunteers, or interns for educational purposes. This may include animal science students, veterinary students, veterinary technicians, veterinary colleagues, and fellow DVMs undergoing integrative training. The nature of these visits will be observational-only, unless specific consent is obtained prior to any hands-on training.
• I understand my animals may need to be restrained during the course of treatment to protect both the animal and the staff. I authorize Twin Willows Integrative to use restraint at their sole discretion to facilitate the treatment of my animal.
• I understand that Twin Willows Integrative is not a full-service veterinary practice, and that Dr. McElrath’s practice is strictly limited to acupuncture and spinal manipulation. I further understand that during the course of treatments, if unforeseen conditions arise that may necessitate the performance of additional procedures/diagnostics, my animal will be referred back to their primary veterinarian. Should any emergencies arise during appointments with Dr. McElrath, I understand that I will be contacted to transfer my animal to a full-service veterinary hospital.
• I give Twin Willows Integrative permission to freely communicate with my animal’s primary and specialty care veterinarians. This communication may include, but is not limited to, the exchange of medical records, patient updates, discussions of medications, and recommendations for testing or treatment plans.
• I understand that there are certain risks and complications associated with most therapies and with the use of any medication, herbal prescription, or supplement.

24-hour cancellation policy: Any appointment missed, cancelled, or changed without 24-hour notice will result in a charge equal to 50% of the reserved service amount.

I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.