Consent To Treat

Consent to Proceed with Acupuncture

I am aware that acupuncture can help many animals, but like any therapy, it will not help every pet. If the history and physical examination leads to the conclusion that acupuncture is not appropriate for my pet, I understand that Dr. Ungar will refer me to my pet’s primary care veterinarian for further care.

I understand that the acupuncture session may consist of needles only, needles with electrical stimulation, or injection of liquid under the skin.

I recognize that acupuncture is considered a form of integrative veterinary medicine and that other treatment options may be available. I am aware that the practice of veterinary medicine (traditional Western, traditional Chinese, or integrative) is not an exact science and thus, no guarantee for successful treatment has been made to me. I have had the opportunity to discuss any questions I may have with Dr. Ungar, and have had them answered to my satisfaction.

By checking the box below and filling in my name, I am certifying that I am the Owner (or agent of the Owner) of the patient named above, I agree to the above statements, and that I have the authority to execute consent for this procedure.

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