Small Animal Chiropractic Progress Visit
This Google Form is utilized for established small animal chiropractic patients WITHOUT a new musculoskeletal problem to evaluate chiropractic progress appointments are 30 minutes of focused time on musculoskeletal recheck, treatment, and case management. 

If you are looking to have a maintenance adjustment on your dog that has been evaluated in the last 6 months and you do not need additional consultation evaluation, then you do not need to fill out this form. Chiropractic adjustment only canine visits are 15 minutes of time focused on your pets adjustment and are reduced in cost. If you want additional add-on services like kinesiology taping, laser, or PEMF treatment, please text or call Dr. Bacon at (970) 450-7300 or the respective clinic location for your treatment to make sure enough time is set aside for your appointment needs. An adjustment only appointment is not appropriate for dogs with new problems or concerns.

If you need additional time for consultation of other problems, or want additional treatment, please continue to fill out this form and select additional services at the bottom of this document AND contact the respective location or Dr. Bacon to arrange additional time.

If you have received this form in error and need to establish a new patient or work-up a new problem, please send a reply email to drmegbacon@mediceininmotionvet.com to receive the correct link and form or return to the client forms tab at www.medicineinmotionvet.com.

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 *
Has your animal been overall better, worse or the same since your last visit? *
Please elaborate on what you notice is better or worse since the last visit if applicable?
Please list any changes to health since last visit including medical or body worker findings (examples include health conditions, rehabilitation therapies like laser/acupuncture, injuries, surgeries, and radiographs with dates where applicable.)
If you were given any rehabilitation exercises, please let Dr. Bacon know if you feel your animal has been making progress (or not) with any particular exercises. If you have questions regarding any exercises, you may also type those here.
Please list any new supplement or medications in your animals routine since last visit
Please list any other comments, questions or concerns regarding this animal’s chiropractic care follow-up visit here
Please indicate if any contact information (primary veterinarian, alternate handler, alternate concerns) is needed for this animal that differs from the animal’s initial intake information
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, and extended rehabilitation exams. 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 $50/20 minutes. Dr. Bacon may defer to your primary veterinarian depending on your pets needs.

If your animal is receiving in-hospital services in partnership with a local clinic, fees will be different than the Medicine in Motion website, as they are adjusted based on that clinic’s requirements, location, and overhead costs. Also, not all the different service offerings may be available based on the locations restrictions. You should contact the respective clinic directly to let them know of your interest in additional services so they can adjust your appointment time and give location specific information such as estimates.
If you have requested additional services above, would you like an estimate for the additional services you are requesting for this animal? (All chiropractic exclusive service fees and mileage fees are posted at https://medicineinmotionvet.com/services ) *
Dr. Bacon is able to accept multiple forms of payment at time of service or prior to time of service including cash, check, Venmo, Square Credit Card Swiping, and Zelle. 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? (For clients being seen in a hospital setting, it is likely you will be paying directly through the hospital, so you may select — In Hospital Visit)
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