Veterinary Permissions

Veterinary Referral Form

In accordance to the Veterinary Surgeons Act 1966 and the Veterinary Exemptions order 2015, consent for treatment must be obtained from your veterinary surgeon. This ensures treatment for your animal is appropriate and safe. It also develops a clear communication pathway between the professionals caring for your animal.

Please forward this page to your vet, for them to complete.

Veterinary Permissions

Veterinary Practice Name

Name of Referring Vet

Phone:

Owner's Name

Owner's Tel Number

Owner's Email

Owner's Address

Animal Name

Breed

Age and Sex

Relevent Medical History - case notes can be emailed to torib@instructor.net

Current Medication

Any other information

Insurance details (if referral is part of a claim)

I consent for the animal declared on this form to be treated with McTimoney Veterinary Chiropractic techniques and massage therapy by Tori Brown, registered McTimoney Veterinary Chiropractor. I confirm that I have detailed any known conditions which may impact treatment, specifically, any relative contraindidcations where treatments should be adjusted/witheheld.

Check to give consent

Follow Me

Stay in touch with me on social media and find out more about what I do, as well as sharing useful information for your pets.

10 Forest Grove, Barton, Preston, PR3 5AY, United Kingdom | 0773 4408539

Created with

In order to provide you with the best online experience this website uses cookies. By using our website, you agree to our use of cookies. More Info.