Chiro4Critters Policies & Consent

Before scheduling your animal, Chiro4Critters requires all new clients to agree to strict appointment policies.

INSTRUCTIONS

Once you’ve submitted your agreement to our Policies & Consent, you will then be able to continue with scheduling your pet for an appointment with Dr. Kremer.

These policies are in place in an effort to ensure each and every client/pet is treated with the highest level of care and attention.

Thank you for helping to make Chiro4Critters possible.

Full Name *

Your full, legal name.

CHIRO4CRITTERS POLICIES *

Check the box beside each policy indicating you agree.

CANCELATIONS/NO SHOWS: Any appointment not canceled prior to 24-hours will incur a charge of $25, including NO-SHOWS. Dr. Kremer has a wait-list and last minute cancelations are both difficult to fill and costly.

LATE ARRIVAL: If you're 10+ minutes late for your scheduled appointment (with/without notice, FOR ANY REASON), you are considered late. A $25 charge is due, this appointment is treated as a missed appointment, and your pet cannot be seen.

DOGS ON LEASH: All dogs must be on a leash at all times. This is for safety reasons.

CHILDREN (younger than 12-years old): For the safety of children, Dr. Kremer, yourself and your animal, absolutely NO CHILDREN are allowed within the facility for any reason. There are no exceptions to this.

NON-COMPLIANCE FEES: Any missed or policy violations resulting in an appointment not able to be completed will have a $25 fee due immediately; and no future services will be rendered until collected.

I agree to all the policies above and all fees associated with non-compliance.

Signature *

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Date Signed *

CHIROPRACTIC EXAMINATION & CARE CONSENT FORM

I, the owner/handler of the animal signing this form, and being eighteen years of age or older, do understand, substantiate, and authorize the following:

Acknowledgments: *

Dr. Amanda Kremer is a Doctor of Chiropractic, licensed in the care of humans. She has attended several hundred hours of education specific to Animal Chiropractic, and is Certified by the American Veterinary Chiropractic Association.

Dr. Amanda Kremer is NOT a Veterinarian, and cannot take responsibility for the primary care of my animal.

Chiropractic care IS NOT intended to replace appropriate Veterinary care, but intended to be used concurrently.

I realize there can be no guarantee as to the nature of my pet’s condition or the outcome of any procedure, and that the services are to only provide relief from everyday stresses put on the animal by performance.

I hereby authorize Dr. Amanda Kremer to adjust my animal with Animal Chiropractic. I certify that my animal has had regular veterinary care and is now concurrently being treated by the veterinarian listed below.

I also certify that I have been open and honest with Dr. Amanda Kremer as to any and all examinations, diagnostic tests, diagnosis, and treatments for my animal’s conditions. I have read this authorization form, and understand it and give my consent.

I understand that a Veterinarian referral is required prior to receiving specialized chiropractic care. Chiro4Critters will send a referral request on your behalf to your Veterinarian.

ALL boxes must be checked or your visit cannot be scheduled.

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Date Signed *

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