Follow the steps to successfully complete the referral form.

1. Click the ‘Get Form’ button to access the referral form and open it in your preferred online editor.
2. In the first section, enter the owner's name in the provided space. This indicates who is requesting the chiropractic care for the patient(s).
3. List the names of the patient(s) who require chiropractic care. Use the space provided for up to four animals, ensuring clarity for each entry.
4. Acknowledge understanding that chiropractic therapy is considered alternative under state law by confirming your acceptance in the designated space. This affirmation is crucial for legal compliance.
5. Input the owner’s contact number to facilitate any necessary communication regarding the referral.
6. The owner should provide their signature in the specified area to authorize the chiropractic referral, affirming that the information provided is accurate.
7. Moving on to the referring veterinarian section, the veterinarian’s name should be written clearly. This section also requires the veterinarian to confirm the establishment of a valid veterinarian/client/patient relationship.
8. The veterinarian must indicate that they have examined the patient(s) and that chiropractic care is deemed appropriate, which reinforces the referral's legitimacy.
9. The veterinarian is to sign and date the form, providing their clinic details, including name, address, phone, fax, and email for further correspondence.
10. Once the form is fully completed, save your changes, and you can choose to download, print, or share the form as necessary. This allows for easy submission via fax or in-person.

Get started on completing your Animal House Chiropractic Veterinary Referral Form online today!