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Consent for Complementary Therapy

Integrated Veterinary Care · Dr Veerle Dejonckheere MRCVS
Thank you for choosing Integrated Veterinary Care. Please complete this short form before your pet’s first appointment. It only takes a couple of minutes.
Name

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Address

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Pet's name
Pet's age or date of birth
Regular vet practice
About your pet’s treatment
Integrative veterinary medicine works alongside your pet’s regular veterinary care, not instead of it. Depending on your pet’s needs, treatment may include Chinese and Western herbal medicine, acupuncture (including electro- and laser acupuncture), chiropractic and mobilisation, laser therapy, therapeutic exercise, nutritional supplements, medicinal mushrooms and diet advice.
By law, acupuncture and prescribing herbal medicine for animals may only be carried out by a vet.

A note on herbal medicines
Herbal medicines are not licensed veterinary medicines. This means they have not been through the formal licensing process for use in animals, which is usual for herbal products. Dr Dejonckheere prescribes them based on her clinical judgement, research and experience. As with any treatment, side-effects are possible, so please let her and your regular vet know if you notice any changes in your pet.
Your consent
By ticking the box below, I confirm that:
• I am the owner of this pet (or acting on the owner’s behalf) and I am over 18.
• I would like Dr Veerle Dejonckheere to provide complementary treatment for my pet, which may include any of the therapies above.
• I understand that Dr Dejonckheere works alongside my regular vet and does not provide routine, emergency or out-of-hours care. In an emergency I will contact my regular vet.
• I understand that herbal medicines prescribed are not licensed for use in animals and that, as with any treatment, there may be side-effects, including ones not yet known. I consent to their use.
• I agree that Dr Dejonckheere may request my pet’s history from, and share treatment notes with, my regular vet and any referral vet involved in my pet’s care.
Please sign here (use your finger on a phone, or your mouse)
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Your details are kept securely, used only for your pet’s care and shared only with the vets involved, in line with UK data protection law (UK GDPR).
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Consent for Complementary Therapy