Welcome!
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. Dr. Bacon uses owner assistance to provide her services, similar to an ambulatory animal chiropractor. 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. Due to COVID19, masks may be worn during small animal appointments at this time pending hospital policies. 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.

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. You will be provided with records from your visit to your email, and a set of medical records will also be sent to your primary veterinarian should you and/or your veterinarian wish a copy.

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 . You can also follow Medicine in Motion Veterinary Services on the web or facebook for up-to-date information regarding travel schedules, as well as fun images and information regarding animal chiropractic. Visit https://medicineinmotionvet.com/ or https://www.facebook.com/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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Owner Contact Email (Email is used to send you a digital copy of records from your visits) *
Owner Contact Phone Number(s) *
Owner Address
If your pet has not seen a veterinarian within the last year, please 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.) 

Or, if a current VPCR cannot be verified by a primary veterinarian or medical paperwork associated with the animal, then an integrative health exam +/- the actual chiropractic treatment will be done instead of chiropractic only initial evaluation. This ensures the application of chiropractic treatment is appropriate and safe for your pet.
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Primary Veterinarian/Hospital (If your animal does not currently have a primary doctor, please type No current doctor.) *
Primary Veterinarian/Hospital EMAIL and PHONE NUMBER
Pet Name *
Species *
Breed *
Estimated Weight/Size (This helps with room scheduling if being seen at an animal hospital) *
Approximate Age/Birthdate *
Sex
Clear selection
Has your animal received chiropractic before? *
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)
Current medications and/or supplements.

Please include situational medications or treats such as CBD, trazodone or gabapentin. If using homeopathy, please put the medication, amount, frequency and what it is prescribed for by your provider
Current exercise types/amounts (walks/week, running, fly ball, working livestock, protection, etc)
Current Behavioral Concerns, if any. 

Please include if your animal has ever needed a muzzle in the past or if there are areas of sensitivity to touch (head, ears, mouth, belly, tail, or feet). Note that even some of the “best animals” may need a muzzle for first time adjusting for safety of handler and the Doctor, as chiropractic can be “surprising” for the pet the first time. Dr. Bacon may use a basket muzzle or cone for this purpose.

Please also include if your animal experiences nervousness at the veterinary office (only because some of the handling may seem similar to a veterinary exam to your pet.)
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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. AND, 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 service fees and mileage fees are posted at https://medicineinmotionvet.com/services, however in-hospital services should have estimate requests done directly through the respective hospital as their prices will defer from those listed.
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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, 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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