Returning Acupuncture Patient Form
Medicine in Motion Veterinary Services LLC is owned and operated by Dr. Meg Bacon (DVM). Appointments are approached using both Western and Eastern Veterinary Medicine outlooks for optimum results.

A set of medical records will also be sent within about a week to your primary veterinarian should your veterinarian wish a copy. TCVM new problem appointments typically are an hour or a little more in the physical visit itself and Progress Acupuncture typically are about 40 minutes. Dr. Bacon spends time evaluating your history you submit here prior to the appointment.

Please let the Doctor know if your contact information or address have changed, and have your pet prepared for the appointment with the following guidelines:

- this form filled out ideally 48 hours or more prior to your appointment

-consider forwarding the most pertinent medical findings (xrays, recent bloodwork, etc) from your primary veterinarian to Dr. Bacon via email at DrMegBacon@medicineinmotionvet.com; Dr. Bacon does not have off-site access to hospital medical records for your pets that are seen at brick and mortar hospital locations

- an appropriate adult handler must be available to help hold your animal

-if your small animal may need a muzzle (basket muzzle preferred), you may bring one of your own if applicable; you may also want to bring your pets preferred treat(s) if he/she has food sensitivities or preferences. Please make the Dr. Bacon and/or the handling hospital aware of major behavioral concerns.

- your pet/horse should be relatively clean and must be dry for needle placement (i.e. horses should be groomed to be free of mud and major shed/hair as well as dry prior to Doctor arrival and small animals should be free from major mats which may get in the way of proper needle placement); if there are weather concerns, rescheduling should be discussed

If you have questions or concerns regarding your 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 if not the owner such as handler/barn manager, and whether such a person has authority to act as the representative agent for the animal(s) examined. One of the listed person's here will be asked to sign a liability waver to allow initiation of treatment of the animal(s) in question.)
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Animal Name *
What is your main concern you wish addressed for your appointment? *
What changes in symptoms or behaviors have you noted since your first visit? (more/less lame, increased appetite, increased willingness to go on walks, increased mobility like going up/down stairs, reduced allergy symptoms)
Please put an alterations to diet (type/amount), medications (drug, dose, frequency of administration) or supplements (type, dose, frequency of administration, purpose) in this space *
Describe your pets current appetite level *
Please describe your pets current fecal consistency *
Please describe your pets urinary habits *
Is your pet currently pregnant? (There are certain points that can help with parturition, which also means they can induce labor/contractions during pregnancy.)
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Please choose the most applicable description of your pets haircoat and/or nails *
HORSE PATIENTS: When were your horse’s feet done last?
Please use this space to describe any changes to medical history (xrays taken, other imaging taken, other treatments undergone, drastic behavior changes)
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 $50/20 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 primary chiropractic/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 but is preferred over Square. 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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