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 integrative care. An adult owner or handler should be available to complete services. Owners/Handlers must be comfortable working within 6 feet of the Doctor. If you have had a possible recent exposure to COVID19, are currently ill, 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 patient records, and to allow her to prepare for your animal’s specific needs. 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 visit, please call Medicine in Motion Veterinary Services at (970)450-7300 or email drmegbacon@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 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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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
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 integrative visit; this is called a current veterinarian-client-patient relationship (VPCR.) Your primary veterinarian may want to run bloodwork, complete xrays (radiographs) or dispense therapeutic medications prior to alternative care. *
Primary Veterinarian/Hospital (If your animal does not currently have a primary doctor, please type NA.) *
Primary Veterinarian contact info: EMAIL and PHONE NUMBER *
Animal Name *
Species *
Breed *
Sex *
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) *
Reason or main concerns for visit —
What treatment styles are interested in discussing such as chiropractic, acupuncture, or herbal therapy?
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Has your animal received integrative care before? *
Please pick the most applicable group of personality qualities of your animal. 

Animals may be a combination, but one of these does tend to stand out as “more this one.”

There are some health conditions listed that MAY occur or have a repeat history of occurring with certain personality types, however, the general personality qualities should be used for final decision making
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EQUINE: When were your horse’s feet done last?
EQUINE: When were your horse’s teeth done last?
Past pertinent medical history including chronic or active health conditions, resolved health conditions (cancer removal, injuries, surgeries), rehabilitation therapies like laser/shockwave/PT, injuries, and advanced imaging like xrays or ultrasound. Dates are extremely helpful. 

If your animals has an xrays or other images, contacting your primary veterinarian to forward records to medicineinmotionvet@gmail.com prior to your evaluation is highly desired.
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/allergies. You may want to bring your preferred high value treat type (or comfort toy) to the appointment
Current medications and/or supplements

Please include legend/adequan, and most recent joint injections locations/dates
Current primary work type and/or exercise types/amounts 

(Examples: trail hiking, flyball, search and rescue, 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)
Current Behavioral Concerns, if any. 

Please include if your horse 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 include whether your small animal does not allow his/her feet and tail to be touched

Please also include if there are difficult behaviors surrounding ears, mouth, or saddling/riding/bridling
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EQUINE Has your horse’s saddle been evaluated for fit?
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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, 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 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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