Initial Consult

Initial Consult Form/Deposit
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Initial Consult
Mobility Consult (Remember, we do not offer any general wellness services)

$150.00

Total

$0.00
Your Name*

First NameLast Name
Your Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Animals Name*
Age*
Sex
Breed*
Color*
Brief Description of reason for the visit:
I understand that the state of Texas considers acupuncture, chiropractic and laser therapy to be alternative treatments. By clicking this box I agree that my pet can receive alternative therapies.I understand the initial consult is $150. Therapies are additional. Acupuncture $80, Chiropractic $60, Laser $60, Shockwave $100. If other treatments are recommended the cost will be discussed at the appointment.I understand the initial consult deposit is non refundable, and there is a $50 fee for cancelling any follow up appointments with less than 48 hour notice.I agree to receive text messages and/or email messages from Back in Motion Veterinary Services.
Signature*

Payment Methods

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Initial Consult Form/Deposit