Referral for Animal Chiropractic Care

Referral for Animal Chiropractic Care

This form is for veterinarians to refer their patients to Animal Chiropractic Care with Dr. Stephanie Winter at Ark Animal Clinic.
Client Name*
Patient Name(s)*
By signing below, I certify and understand the following:
- Dr. Stephanie Winter is a licensed Doctor of Chiropractic In MO, a Graduate from Options for Animals College of Animal Chiropractic, and is Certified by the International Veterinary Chiropractic Association. Dr. Winter maintains all licensure requirements and holds malpractice insurance for her services.
- Dr. Winter does not make any Veterinary diagnosis or recommendations. Dr. Winter only addresses Vertebral Subluxation Complexes.
- Chiropractic care is not a replacement for Veterinary Medicine.
- I have a working relationship with and refer the above listed patient/s for Chiropractic care with Dr. Stephanie Winter.
Veterinarian Name*
Veterinarian Signature*

Clear
Clinic Name*
Clinic Phone*
Please enter a valid phone number.
Clinic Email*
example@example.com
Ark Animal Chiropractic, LLC
Kansas City, MO
Dr. Stephanie Winter, DC, MSW, IVCA, CVMRT
C: 678-471-1491
E/M: drwinter@arkanimalchiropractic.com
www.arkanimalchiropractic.com
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