Tails Animal Chiropractic Care with Dr. Meg Bacon
Dr. Meg Bacon is a veterinarian (DVM) certified in animal chiropractic as well as a Certified Veterinary Acupuncturist (CVA) in Traditional Chinese Veterinary Medicine (TCVM.) You have been asked to fill out this form to streamline your appointment by gathering important information about your pet. If this form is filled out less than 48 hours in advance, it may not have time for thorough review prior to your appointment, especially in pets with lengthy history information.

If you are reading this form, you may have chosen one of the following appointment types:

-Veterinary Traditional Chinese Veterinary Medicine New Patient Exam with acupuncture treatment - TCVM Examination, which is similar to a traditional health exam plus the evaluation of tongue and pulses, with medical history overview; this may include some chinese herbal therapy discussion if applicable and time allows. Treatment consists of the application of dry needles, acupressure, laserpuncture, aquapuncture, or electroacupuncture based on your pet’s Traditional Chinese Veterinary Medicine Exam and diagnoses

-Veterinary Musculoskeletal Evaluation with Chiropractic Treatment - a veterinarian based full musculoskeletal examination including gait analysis, palpation, diagnosis discussion if applicable, and discussion of medical therapy options given findings. Treatment is the application of controlled thrusts to the musculoskeletal system as well as passive range of motion movements to allow full range of motion of all the joints of the body.

-A Combination of both western and eastern evaluations and treatments - a combination of both styles of examinations described above

You may have chosen to add additional time/services to one of your appointment types (These need to be added prior to your appointment so that scheduling time is done appropriately.)
-Consultation Time (add 15 minute blocks) - can be added for additional time to address concerns at any appointment with Dr. Bacon. This may include pain assessment, western pain management option discussion, weight management, or quality of life. Dr. Bacon will be able to provide findings, recommendations, and referrals based on your pet’s conditions to be placed in the medical record sent to you and forwarded to your primary veterinarian of choice. If appropriate records are provided for prescription discussion, that may occur.
-Pain management package - for patients that have undergone one of the main appointment types desiring whatever combination therapy might be appropriate to amplify pain management. May include cold laser therapy (regional or laserpuncture), Pulsed Electromagnetic Field Therapy (PEMF), soft tissue massage/acupressure, and/or kinesiology taping.
-Cold Laser Therapy - regional or local acupuncture point laser therapy targeting your pets most pertinent pain needs

Please have your pet prepared for the appointment with the following guidelines:

-consider forwarding the most pertinent medical findings (xrays, recent bloodwork, etc) from your primary veterinarian to Dr. Bacon via email at medicineinmotionvet@gmail.com

-if your small animal may need a muzzle (basket muzzle preferred), you may bring one of your own if you have one custom to your animal

-You may want to bring your pets preferred treat(s) if he/she has food allergies or preferences. Some treat types are available at our appointment sites. If he/she is not food motivated, but does have a comfort toy or blanket, you may choose to bring that.

- your pet should be relatively clean and must be dry for acupuncture needle placement

If you have questions or concerns regarding your visit, visiting www.medicineinmotionvet.com to look at the Education Tab or FAQ Tab may answer many questions. You are encouraged to visit the FAQ tab, as it discusses how to prepare for your scheduled evaluations. You may be instructed prior to your visit to go to the education tab to access surveys pertinent to your requested appointment. You may look for @MedicineinMotionVet on social media to see videos and pictures of patients receiving treatment. This can sometimes help with your treatment expectations.
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GUARDIAN NAME (First and Last) *
Contact Phone Number(s) *
Contact Email

Email is used to send you reminders and a digital copy of records from your visits. If there are additional person's other than the owner that should receive a copy of chiropractic examination records, you may list them here. Primary Veterinarian Info will be asked later in this document.
*
Animal Name *
Species *
Breed
Primary Color(s)
Approximate Age/Birthdate *
Sex *
Last known weight (estimated weight)
Primary Veterinarian/Hospital (If your animal does not currently have a primary doctor, please type NONE.)
Primary Veterinarian contact info: EMAIL and PHONE NUMBER
What brings you to this appointment? (I.e. what’s your primary concern) *
Has your pet had any diagnostic images taken (xrays, ultrasound, MRI/CT)? If yes, of what?

(It is often helpful to get copies of any images prior to your appointment if possible. Please have them forwarded to medicineinmotionvet@gmail.com )
What type of appointment have you booked through Tail Animal Chiropractic Care?
What are particular concerns that may apply to your visit?
What food brand, amount, and frequency to you feed your pet?
How is you pet’s appetite?
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Is your pet experiencing vomiting?
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What is the consistency of your pet’s stool?
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What’s your pet’s current activity level?
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What other conditions has your pet received a diagnosis for? (thyroid disease, metabolic disease, allergies, skin disease, etc)
What surgical procedures has your pet had other than spay/neuter, if any?
What medications does your pet take?
 (What is it, what is the dose, and the frequency)
What supplements does your pet take?
(What is it, what brand is it, what is the dosage, and the frequency)
Choose the option that best describes your pets sleeping habits
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