Rehabilitation Consent Form

Rehab Consent Form

Referring Veterinarian:

Veterinary Hospital:

Client Name

Patient Name

I am authorizing Tsavo’s Canine Rehabilitation to perform rehabilitation on the above patient. Rehabilitation services may include any or all of the following: Cold Laser therapy, tPEMF, ESWT, PST, E-stim, Acupuncture, Chiropractic, Bodywork, Hydrotherapy.

Date

Referring Veterinarian Signature:

Sign Here