THE UNDERSIGNED hereby certifies that I am the owner of the above named animal and I am over the eighteen years
of age.
The undersigned recognizes and acknowledges that I am seeking a form of treatment for my animal that varies
from traditional evidence-based “Western” veterinary medicine a/k/a “Traditional” veterinary medicine; hereafter complementary and/or alternative veterinary medicine (“CAVM”).
The undersigned understands the diagnostic and/or treatment procedures for CAVM are likely to vary considerably from those offered at “Western” or “Traditional” veterinary clinics, colleges, facilities, hospitals or practices. The types of CAVM treatment includes: (a) acupuncture; (b) acutherapy; (c) acupressure; (d) homeopathic; (e) chiropractic; (f) electrical therapy; (g) food therapy; (h) herbal / plant therapy; (i) holistic medicine; (j) integrative therapies; (k) laser therapy; (l) magnetic therapy; (m) manual / manipulative therapies; (n) massage therapy; (o) nutraceutical therapy; (p) osteopathic; (q) phytotherapy; and/or others.
The undersigned appreciates and understands that not all animal patients can or will benefit from one or more of
these CAVM approaches. The undersigned fully accepts that the attending veterinarian(s) may consider, discuss, recommend and/or suggest other modes of care for my animal including referrals to other veterinarians who practice “Western” or “Traditional” veterinary medicine, board-certified veterinarians in particular veterinary disciplines, or veterinarians who practice a combination of “Western” / “Traditional” veterinary medicine and CAVM.
The undersigned also understands and accepts that the attending veterinarian(s) may decide not to offer or provide discussed or suggested CAVM care for my animal without further clinical or diagnostic evaluation or testing or may decide not to offer such CAVM care because there is no apparent veterinary medical reason that it would benefit my animal.
The undersigned acknowledges and is aware that the practice of veterinary medicine is not an exact science
and, thus, no assurances or guarantees for successful treatment can nor have been made. Further, the Mariposa Veterinary Wellness Center, L.L.C. veterinarian(s) have encouraged me to ask all questions I might have and the veterinarian (s) agreed not to proceed with this CAVM care until each of my questions had been answered to my full satisfaction. Also, with the opportunity to consult with other veterinarians before commencing CAVM care on my animal.
Last, the undersigned consents to the provision of requisite clinical and/or diagnostic procedures and CAVM
treatment provided at Mariposa Veterinary Wellness Center, L.L.C.
