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  • Tuesday/Thursday: 8:00am – 8:00pm
  • Saturday: 9:00am – 12:00pm
Online Product Ordering Book an Appointment
Online Product Ordering Book an Appointment

Acupuncture Referral Form

Client Information

Name
Address
Preferred Form Of Communication

Pet Information

What species is your pet?
Sex
Please pick the the most accurate option. When my pet is at the vet clinic:
Are you a pet owner referring your own pet for acupuncture?
Are you a veterinarian referring a client's pet for acupuncture?
Would you like us to send the records from your acupuncture appointments to the above listed clinic?
If we recommend further testing and treatment for your pet (outside of acupuncture), how would you like us to proceed?
Have you seen a veterinarian for this problem?
Has your pet had labwork (bloodwork, urinalysis, etc) with respect to this problem, or in the past 12 months?
Has your pet had radiographs done for this problem?
Is your pet currently on any medication or supplements?

Please have your vet clinic send any relevant records (including labwork or radiographs) to contact@forestgrovevet.com at least 24 hours prior to your appointment.

(non-electronic records can also be faxed to (306) 955-6101)

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