Consent and Payment Agreement


I, the undersigned owner of the pet identified above, consent to the examination and treatment of my pet with acupuncture, and/or chiropractic, and/or herbs by Lauren Genow, DVM of Prickly Pear Holistic Veterinary Care, LLC. Acupuncture, chiropractic, and herbal therapy are considered to be a part of Complementary and Alternative Veterinary Medicine (CAVM). Acupuncture treatment techniques include but are not limited to the following: dry needling, electroacupuncture, aquapuncture, and moxibustion. I understand that complications of acupuncture are uncommon and include, but are not limited to: broken needle under the skin, needle ingestion, infection, and bleeding. Side effects of herbal therapy can include vomiting and diarrhea but these effects are rare and usually mild. I understand and am informed that in the practice of chiropractic therapy there are some risks to treatment, including but not limited to fractures, disc injuries, strokes, dislocations and sprains. I do not expect the veterinarian to be able to anticipate all risks and complications, and I wish to rely upon the veterinarian to exercise judgement during the course of the procedure, in my best interest, based upon the facts then known to her. ***By inputing my Electronic Signature below, I agree to pay any expenses associated with care provided by Prickly Pear Holistic Veterinary Care, LLC.***