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Medicine in Motion Veterinary Services LLC is owned and operated by Dr. Meg Bacon. She frequently operates without the assistance of a veterinary technician to provide a variety of examinations and her full chiropractic services, and so an adult owner or handler should be available to complete services. Owners/Handlers must be comfortable working within 6 feet of the Doctor or understand that certain adjustments cannot be completed on the animal due to the safety of the Doctor and/or the animal. Care is taken by the Doctor to remain masked when working in close proximity with unvaccinated individuals, and to clean the equipment between appointments at different facilities. Dr. Bacon is vaccinated against COVID19. Masks are to be worn by all owners or animal handlers when working indoors or in close proximity during appointments if not vaccinated. If you have had a possible recent exposure or are not comfortable working near the doctor, please find an alternative handler for the appointment or reschedule. If you/your handler has been vaccinated against COVID19, please let the Doctor know, as masks may become optional.

The following form is used to complete the background information for Dr. Bacon’s chiropractic records, and to allow her to prepare for your animal’s specific needs. Initial chiropractic visits include getting to know your animal while discussing history, basic conformation evaluation, brief gait analysis, musculoskeletal palpation, chiropractic motion palpation, and chiropractic adjustments where needed. This Google Form is utilized for chiropractic exclusive care questions. Full chiropractic appointments are 45 minutes to 75 minutes focused on the musculoskeletal system and treatment. If you need additional time for consultation of other problems, or want additional therapies, please select the additional services at the bottom of this document AND contact Dr. Bacon if you may need to arrange additional time.

If you have questions or concerns regarding your chiropractic visit, please call Medicine in Motion Veterinary Services at (970)450-7300 or email customerservice@medicineinmotionvet.com or visit www.medicineinmotionvet.com to look in our Education Tab or FAQ Tab. You are encouraged to visit the FAQ tab, as it discusses how to prepare for your scheduled evaluations. Feel free to follow Medicine in Motion Veterinary Services on social media for message posting, good information, and fun pictures @MedicineinMotionVet.

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NAME (First and Last) 

(Please indicate relationship to animal if not the owner; Liability waiver must be filled out by the animal owner giving permission for treatment and identifying alternative handlers)
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Animal Name *
Owner Contact Phone Number(s) and Handler Contact Phone number if applicable *
Owner Contact Email 

Email is used to send you appointment confirmation reminders and to give you a digital copy of records from your visits. If there are additional person's other than the owner that should receive a record, you may list them here. Primary Veterinarian Info will be asked later in this document.
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Animal Location Address

Please provide any additional direction instructions if necessary for your locations like where to park, building location, gate codes, etc
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Is there somewhere to be protected from weather with dry/level footing at your animal’s location?

Animal’s with appointments at locations without weather protection have potential for rescheduling due to poor weather conditions like severe wind or precipitation due to safety.
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If your animal(s) have not seen a veterinarian within the last year, please try to schedule a regular health check-up with your primary veterinarian prior to your chiropractic visit; this is called a current veterinarian-client-patient relationship (VPCR.) 

If a current VPCR cannot be verified by a primary veterinarian or medical paperwork associated with the animal, then a integrative health exam may need to be done by Dr. Meg Bacon prior to any treatments to help ensure safety for your animal. These would be associated with appropriate fee changes depending on your services requested. A valid VPCR is required by law to dispense medical advice and work with your animal. This ensures your animal’s overall well-being and mitigates risks to your animal’s health with the application of some treatments such as chiropractic care.
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Primary Veterinarian/Hospital (If your animal does not currently have a primary doctor, please type No current doctor.)
Primary Veterinarian contact info: EMAIL and PHONE NUMBER *
Species *
Breed
Sex
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Approximate Age/Birthdate
Primary Color(s) (feel free to put any additional identifying information/markings here)
Estimated Height/Weight/Size (This helps the Doctor with potential equipment choices)
Current primary work type and/or exercise types/amounts 

(Examples: Dressage, Trail Riding, Barrel Racing, 4H Show animal, lessons weekly, trail riding 3x week, etc; You may also choose to put your goals for work in this section should you wish. If your horse is a driving horse, please put location in the team if teamed performance.)
Has your animal received chiropractic before?
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When were your horse’s teeth done last?
Has your horse’s saddle been evaluated for fit?
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Reason or main concerns for visit *
Past pertinent medical history (health conditions, rehabilitation therapies like laser/acupuncture, injuries, surgeries, and radiographs with dates where applicable.)
Current Diet

Type and Amount, please include treats; this helps with Body Condition Scoring or Nutritional Consultation if needed. Please also indicate if your animal may have treats at the appointment, and if there are any dietary restrictions/preferences.
Current medications and/or supplements

Medications should include the drug, the dosage and the frequency. Please include things like legend/adequan, and most recent joint injections locations/dates)
Current Behavioral Concerns, if any. 

Please include if your animal does or does not stand well for the farrier, if he/she has had tendency to be mouthy, bite, strike, or kick in the past, or if there are areas of sensitivity to touch (head, ears, mouth, belly, flank, tail, or limbs/feet).  

Please also include if there are behaviors surrounding saddling/riding/bridling such as girthiness, head throwing, neck bracing, bucking, or kicking out.
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When were your horse’s feet done last? (You may wish to list your preferred farrier here)
Please select any additional services that you know that you would like with this visit for this particular animal. Please note that these additional services have additional fees as their time commitment will go beyond the typical appointment time. Brief consultations (<10 minutes per topic) regarding at-home exercises, minor behaviors, pain management, and quality of life do not carry extra fees, as they are considered part of Dr. Bacon’s complete care. Pre-selecting your choices here helps Dr. Bacon to best create/adjust time allotted for your visit that goes beyond the typical evaluation. 

Many of the fees for ambulatory exams and services can be found at https://medicineinmotionvet.com/services . 

Advanced Consultation Services include lameness exams, neurologic exams, extended rehabilitation exams, and ridden evaluations. These are $100/20 minutes of on-site work since 10 to 20 minutes off-site will be used for video analysis, picture analysis, rehabilitation exercise write-ups or other extended write-up time.

General Consultation Services revolving around just on-site time such as behavioral consultation, Pain management consultation (medications, supplements, prescriptions, pain scoring, etc), and Quality of Life consultations (surveys, pain control, alternative therapy options) are only $50/15 minutes.

If your animal is receiving in-hospital services in partnership with a local clinic, fees may be different than the Medicine in Motion website, as they are adjusted based on that clinic’s requirements, location, and overhead costs. You should also contact the respective clinic directly to let them know of your interest in additional services so they can adjust your appointment time.
If you have requested additional services above, would you like an estimate for the additional services you are requesting for this animal? (All chiropractic and acupuncture service fees and base mileage fees are posted at https://medicineinmotionvet.com/services )
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Dr. Bacon is able to accept multiple forms of payment at time of service or prior to time of service including cash, check,  Zelle transfer, Venmo, and Square Credit Card Swiping. Cash, Check, and Zelle transfer are preferred as they carry no transaction fees from credit card or servicing companies. Venmo business now charges a transaction fee to sellers, similar to any other credit card company. Invoicing is available for developed clients only. For areas with no cell service or WiFi, a down payment may be requested prior to service. How would you like to pay for services for the appointment? *
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