I have engaged Dr. Kristi Jackson (hereafter “Veterinarian”), a licensed veterinarian and the Blue Run Veterinary Practice to perform complementary and/or alternative veterinary treatment on my animals, including chiropractic, laser therapy, Traditional Chinese Medicine including acupuncture, herbal therapy, food therapy, or other alternative and complementary medicine, which treatment has been described and explained to me, to my satisfaction, by Veterinarian.
I hereby fully consent to and authorize the performance of such complementary and/or alternative treatment by Dr. Jackson, including any preliminary, further, or additional treatments, therapies, tests, medications, herbs, or injections that may be, in the judgment of Veterinarian, or any veterinarian associated with her, considered advisable or necessary at any time while the complementary and/or alternative medical treatment is being performed.
The intention of this Consent is to grant full authority to Dr. Jackson and any veterinarian associated with her and their respective employees, assistants or consultants, to administer and perform any and all complementary and/or alternative medical, drugs, treatments, tests, medications, injections or diagnostic procedures to my animal(s) that may be deemed advisable or necessary by Veterinarian or by any veterinarian associated with her.
I have been fully informed, to my satisfaction, by Dr. Jackson that complementary and alternative veterinary medicine may be considered by some in the American veterinary profession as a philosophy or practice that 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 complementary and alternative veterinary therapy: (a) 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; (b) it may have no effect; (c) my animal(s) may experience some discomfort from complementary and alternative treatments; (d) complementary and alternative veterinary treatment 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; and (e) adverse effects may include, but not be 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(s) may not respond nor benefit from complementary and alternative veterinary treatment. I also understand that it is important for me fully to follow Dr. Jackson’s instructions on monitoring my animal(s) such as, but not limited to, blood, stool, and urine tests, over the course of their complementary and alternative veterinary treatment and promptly and fully to report to Veterinarian, or any veterinarian associated with her, any adverse effects or unusual behavior by my animal(s).
I further understand that if my animal(s) is seen by another veterinarian, not associated with a Veterinarian while undergoing or having undergone complementary and/or alternative veterinary treatment, I should fully inform the other veterinarian that my animal(s) is on or has undergone a complementary and/or alternative veterinary treatment, the nature of the complementary and/or alternative veterinary treatment, and request the other veterinarian to contact Veterinarian or a veterinarian associated with her.
