Veterinary Referral Form

First Name  (Owner) is requesting authorization for a veterinary referral for chiropractic care for His/Her pet   First Name.  He/She requests that chiropractic services be provided by Dr. Abby Esau, D.C., at Bit & Bone Animal Chiropractic.   First Name has been provided with the risks and benefits associated with animal chiropractic and understands that His/Her referring veterinarian will not be held liable should any negative reactions to chiropractic care occur.   First Name   also understands that the employees of Bit and Bone Animal Chiropractic are NOT veterinarians and they do not intend to replace traditional vet care or take responsibility for my animal’s primary healthcare needs.

I,   First Name*   Last Name*   (referring veterinarian), herby authorize Dr. Abby Esau D.C. to provide chiropractic care as needed for the patient(s) identified above. This referral is in compliance with the laws of the Texas Board of Veterinary Medicine.