Registration Form - Acu Braun Veterinary Housecalls
  • Registration Form - Braun Veterinary Housecalls

    WE KNOW YOUR PET’S HEATH IS IMPORTANT AND WE THANK YOU FOR TRUSTING US TO CARE FOR THEM. TO HELP USPROVIDE THE BEST CARE POSSIBLE, PLEASE TAKE A FEW MOMENTS TO FILL OUT THIS FORM COMPLETELY. THANK YOU!
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • AUTHORIZATION
    I hereby fully consent to and authorize the performance of such acupuncture treatment by Jana Braun, DVM, CVA, including any preliminary, further, or additional acupuncture treatments, therapies, tests, medications or injections that may be, in the judgment of Dr. Braun, or any veterinarian associated with her, considered advisable or necessary at any time while the acupuncture
    treatment is being performed.

    The intention of this Consent is to grant full authority to Dr. Braun, and any
    veterinarian associated with her and their employees, assistants or consultants, to perform and administer any and all acupuncture treatments, drugs, medications, tests or diagnostic procedures on my animal(s) that may be deemed advisable or necessary by Dr. Braun, or any veterinarian associated with her.



    I have been fully informed, to my satisfaction, by Dr. Braun that acupuncture is a
    complementary or alternative veterinary medical treatment, therapy or procedure. Also, I have been advised that complementary and alternative veterinary medicine does or may be considered by some in the American veterinary profession as a philosophy or practice that does or may differ from current scientific knowledge, or whose theoretical basis and techniques do or may diverge, even considerably, from veterinary medicine routinely taught in accredited veterinary colleges in the United States.


    I have also been fully informed, to my satisfaction, by Veterinarian, that acupuncture involves the insertion of a needle(s), electro-stimulation, injections of small substances. 

    I understand that acupuncture: (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 acupuncture treatment; (d) acupuncture therapy 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; 

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  • Please sign if you understand these risks and would like to proceed with low level laser therapy. I will provide laser protective glasses for you and your pet. You agree to wear them.

    If you pet does not tolerate them, you understand the very small risk of eye damage if he/she looks directly at the laser.
    Please let me know if there are areas on your pet you would like avoided.

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