chariot vet consent

To comply with the veterinary surgeons’ act 1966 permission to give massage therapy must first be granted by the veterinarian the animal is register with. At this time, I (Alice Hill Aka Chariot Sports Massage) am a student of Centaur Equine Massage Therapy Training, accredited by ukruralskills, undertaking case study work to complete training.

Name

Contact number

Yard Address

Vet Details

name, practice and address

Horse Name

Breed

Age

Sex

Height

Colour

I give permission for my horse's details to be shared with Chariot Sports Massage (Alice Hill) by the registered vet or practice colleagues.

please check here, sign and date below that you (the owner) consent.

Signature

Clear

Date

To be completed by the consenting veterinary surgeon.

Client signiture may not be visable on mobile but should show on desktop.

Name of consenting veterinary surgeon

Contact phone number

Email

example@example.com

Brief relevant medical history including any injury, complaint, areas of caution etc

Consent is required for future maintenance massage

Yes No

I confirm that the animal detailed is currently under my care and is in a fit condition to receive this therapy.

Clear

Dated

Date

Chariot Sports Massage, Mobile: 07885658184 email: alicechill@hotmail.co.uk