Integrative Veterinary Care Welcome Form

Integrative Veterinary Care Welcome Form

Integrative Veterinary Care Welcome Form
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Address
Address
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Location - We are located at 4019 Lincolnway East in Mishawaka, IN. We are in the Twin Branch area near the Lincolnway & Bittersweet intersection.
Pawsitive Integrative Veterinary Care does everything they can to stay on schedule and make it fair for each pet to get their amount of time needed for their exams so we can live up to our standard of care. Due to this if you are more than 5 minutes late to your appointment you will be asked to reschedule. Please acknowledge that you have read and understand this policy.
Pawsitive Integrative Veterinary Care has a No Call, No Show/Cancellation Policy that is as follows - We require 24 hours notice for any canceled appointments. Due to the amount of patients we are serving our appointment times are very valuable. If you are unable to make your appointment and do not give us proper notice a fee equivalent to the price of the exam will be assessed on the account and must be paid before we can reschedule.

To book my first appointment with Pawsitive Integrative Veterinary Care I understand that I must watch the Empower Pet Parent Course by Marlene Siegel, located here: https://transformingvetmedicine.com/empowered-pet-parent-course/

This course will help explain what we do and why. It also will make your visit much more beneficial. The first module is free for our clients The video was created by Dr. Anderson’s colleague and mentor who has over 20 year's experience with Integrative care. We believe by watching this it can help you understand what all integrative medicine is about.

To book my first appointment with Pawsitive Integrative Veterinary Care I understand that I must watch the Empower Pet Parent Course by Marlene Siegel.

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Do you agree to receiving text messages from Pawsitive Integrative Veterinary Care and it's sister clinic, Lincolnway Veterinary Clinic?
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Additional Pets

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I hereby grant Pawsitive Integrative Veterinary Care and it's sister clinic, LincolnwayVeterinary Clinic, permission to use my pet's likeness in a photograph, video or otherdigital media ("photo") in any and all of it's publications, including web-basedpublications and social media, without payment or other consideration.I understand and agree that all photos will become the property of PawsitiveIntegrative Veterinary Care and will not be returned.

I hereby irrevocably authorize that Pawsitive Integrative Veterinary Care to edit,alter, copy, exhibit, publish or distribute these photos for any lawful purpose. Inaddition, I waive any right to inspect or approve the finished product wherein mypet's likeness appears. Additionally, I waive my right to any royalties or othercompensation arising or related to the use of the photo.

I hereby hold harmless, release and forever discharge Pawsitive IntegrativeVeterinary Care and it's sister clinic, Lincolnway Veterinary Clinic, from all claims,demands and causes of action which I may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRMTHAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OFAGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MYPARENT/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW.

Do you agree to our Social Media Release as seen above?
Do you authorize the veterinarian(s) at Pawsitive Integrative Veterinary Clinic to examine, prescribe, and/or treat the described pet(s), assuming responsibility for all charges incurred at the time and care of your pet(s)?

I have engaged Dr. Anderson, a licensed veterinarian and the Lincolnway Veterinary Clinic or Pawsitive Integrative Veterinary Care to perform integrative and/or holistic treatments or therapies on my animal. The treatment or therapy has been described and explained to me to my satisfaction by Dr. Anderson or one or her associates.

I hereby fully consent to and authorize the performance of such integrative and/or holistic treatment by this facility, including any preliminary, further, or additional treatments, therapies, tests, medications, herbs or injections that may be, in the judgment of Dr. Anderson or any veterinarian associated with her, considered advisable or necessary at any time while the integrative and/or holistic treatment or therapy is being performed.

The intention of this consent is to grant full authority to Dr. Anderson and any veterinarian associated with her and their respective employees, assistants and consultants, to administer and perform any and all integrative and/or holistic medical, drugs, treatments, tests, medications, injections or diagnostic procedures to my animal that may be deemed advisable or necessary by Dr. Anderson or any veterinarian associated with her.

I have been fully informed, to my satisfaction, by Dr. Anderson that integrative and holistic veterinary medicine does or may be considered by some in the American veterinary profession as a philosophy or practice that does or may differ from current scientific knowledge, or whose theoretical basis and techniques may diverge, even considerably, from veterinary medicine routinely taught in accredited veterinary colleges in the United States.

I understand that integrative and/or holistic veterinary therapy:

  • Is not like most conventional or drug therapies, in that it has or may have multiple effects on many systems in an animal at a time
  • It may have no effect
  • My animal may experience some discomfort from integrative and/or holistic treatments or therapies
  • Is usually, but not always safe and it may have side effects that may be the same or more severe than conventional drugs or other treatments.
  • May have adverse effects including, but not limited to, illness, known or unknown interactions, nausea, vomiting, diarrhea, constipation, muscle spasms or more serious, unforeseen effects including, in rare situations, stroke, paralysis or death.

I appreciate that my animal may not respond nor benefit from integrative and/or holistic veterinary treatment. I also understand that it is important for me to fully follow Dr. Anderson's instructions on monitoring my animals such as, but limited to, blood, stool and/or urine tests, over the course of their treatment and promptly and fully report back to Dr. Anderson or any veterinarian associated with her, any adverse effects or unusual behavior.

I further understand that if my animal is seen by another veterinarian not associated with Dr. Anderson or this facility while undergoing or having undergone integrative and/or holistic veterinary treatment that I should fully inform the other veterinarian that my animal is on or has undergone an integrative and/or holistic treatment, the nature of the treatment, and request the other veterinarian to contact Dr. Anderson or a veterinarian associated with her.

I HAVE FULLY READ THIS CONSENT FORM BEFORE SIGNING IT AND DR. ANDERSON OR ONE OF HER ASSOCIATES HAS ANSWERED, TO MY COMPLETE SATISFACTION, ANY QUESTIONS I HAVE ASKED HIM OR HER ABOUT INTEGRATIVE AND/OR HOLISTIC VETERINARY MEDICINE, RISKS ASSOCIATED WITH INTEGRATIVE AND/OR HOLISTIC VETERINARY MEDICINE, OTHER NON-ALTERNATIVE TREATMENTS, THERAPIES, PROTOCOLS OR PROCEDURES THAT ARE OR MAY BE AVAILABLE OR POSSIBLE FOR MY ANIMAL AND I HAVE FREELY AND KNOWINGLY SIGNED THIS CONSENT FORM.