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Please fill out this form before your call with Dr. Beebe.

VETERINARIAN-PATIENT REGISTRATION 

Species

DIET

DIAGNOSIS

CURRENT MEDICATIONS, HERBAL FORMULAS AND SUPPLEMENTS

MEDICAL RECORDS, LABORATORY AND OR OTHER DIAGNOSTIC REPORTS

Please email all medical records (SOAP) and reports from the last 12 months for a comprehensive and accurate evaluation of your case. Include any and all histopathology reports for all patients.

By signing this form, I understand the following:

 

  • A variety of alternative and integrative method/options for veterinary care are available depending on the condition of the individual patient. Dr. Signe Beebe is consulting on alternative and integrative methods of treatment including, but not limited to, acupuncture, Chinese herbs, Chinese food therapy, intravenous vitamin C, prolotherapy, neural therapy, gold wire implantation, veterinary Tuina, laser therapy, ozone, microbiome restoration, veterinary manipulative therapy (chiropractic), ozone therapy and nutritional supplements, some of which may or may not be recognized as standard methods of treatment by the American Veterinary Medical Association (AVMA) as well as conventional medicine.

  • I understand that recommendations for the treatment of all pets are in accordance with prevailing standards of competency in the above-described modalities of treatment as recognized by the AVMA, American Academy of Veterinary Acupuncture, the International Veterinary Acupuncture Society, the Chi University of Traditional Chinese Veterinary Medicine, the American Holistic Veterinary Medicine Association, The Veterinary Botanical Medicine Association and the American College of Veterinary Botanical Medicine. No guarantee or assurance has been made as to the result that may be obtained from the advice given. 

  • A written report can be requested and provided within 5 business days of the initial consultation.

  • Consulting Fees: Are payable 3 business days prior to the consultation or recheck

  • Cancellation Policy: Please reschedule or cancel your consultation a minimum of 48 hours prior to your scheduled time. If you cancel in less than 48 hours, a cancellation fee may apply. (Please sign below)

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