New Patient Forms

Part of Wellness Waggin’s protocol is to provide pet owners with information to assist in making informed choices about treatment options for their pets. This process is often referred to as “informed consent” and involves a pet owner’s understanding and agreement regarding the care recommended (which is based primarily upon an initial examination of the pet and the information the client has provided to the veterinarian), the benefits and risks associated with the care, alternatives, and the potential effect on a pet’s health if the client chooses not to accept the treatment plan. As acupuncture and cold laser therapy are not intended to substitute for clinical veterinary medical care, it is expected and assumed that the client’s pet is under the care of a treating veterinarian who has provided up-to-date vaccinations and regular medical care, as needed.

ACUPUNCTURE
Acupuncture is a form of therapy in which fine needles are inserted into specific points on the animal’s body resulting in the stimulation of a specific point on the body (acupuncture point or acupoint) for a healing effect. The pet’s treatment may consist of needles only (dry needling), needles with electrical stimulation, needles with moxibustion (burning of a substance), needles used with essential oils or Aqua-acupuncture, where a liquid substance (Vitamin B12, Adequan, Traumeel, for example) are injected into an acupuncture site. Wellness Waggin’ uses single-use, sterile, disposable needles for acupuncture. Acupuncture is generally very safe and well tolerated by many animals.

COLD LASER THERAPY
Laser therapy is a pain-free, drug-free, non-invasive procedure that uses light energy, a process called photobiomodulation, to help stimulate healing and reduce pain and inflammation. Laser therapy is considered to be highly effective and very well tolerated by many animals. Laser therapy treatments last about 5-15 minutes and most conditions require multiple sessions. The frequency and duration of the treatment protocol is determined on a case by case basis. The treatments can be a stand alone therapy or, more commonly, combined with other modalities such as acupuncture, Chinese Herbals or The Assisi Loop.

CLIENT’S ACCEPTANCE OF TERMS for TREATMENT AND SERVICES:
In addition to the verbal discussions between the client (named above) and Dr. Schepps regarding the pet’s (named above) treatment by Wellness Waggin’, the following document must be completed by the animal’s owner to verify consent for treatment. The pet owner’s acceptance and agreement with the following statements shall be evidenced by the placing of a check in the spaces provided and by typing your name (digital signature) in the box provided. A printed copy of the Informed Consent Agreement is available upon request.

I certify that I am over eighteen years of age, own the above-mentioned animal and am requesting veterinary acupuncture care or laser therapy treatment of my pet (including any other products or services that Dr. Mitzi Schepps reasonably believes will be in the best interest of my pet).
I have received an estimate of the costs for my pet’s current treatment.
I have fully informed Dr. Schepps of my pet’s medical history such as seizures, cardiac issues, inability to stand/walk, bleeding or skin disorders, cancer, allergies and any medications (including bad reactions), and behavioral history such as aggressive tendencies and fears, and understand that Dr. Schepps is relying upon this information to treat my pet. I choose to rely on Dr. Schepps’ best judgment during the course of treatment which she reasonably believes at the time, is in my pet’s best interest and has been based upon the information that I have provided.
I have been encouraged to ask questions and discuss any concerns I have with Dr. Schepps – especially regarding the risks and the benefits involved – before any treatment and/or procedure is initiated.
I acknowledge and accept that it is not possible to define or consider every possible outcome that might arise during the care and treatment of my pet. However, Wellness Waggin’ takes numerous precautions against risks, such as single-use, sterile disposable needles and maintaining a safe working area in our home. I have been informed of some possible side effects that might be exhibited by my pet such as, but not limited to, lack of appetite; fatigue; needle-break in skin; ingestion of needle (which usually passes through in your pet’s stool); bruising or bleeding at the site; elimination during treatment and possible hyperactivity may occur after treatment. I am also aware that, although rare, needles can be lost in a pet’s coat or can be shaken out by the pet, making the tiny needles difficult to find in the home. In addition, I have been informed that acupuncture and/or cold laser therapy are generally safe methods of treatment, but, as with all types of veterinary healthcare interventions, there are some risks involved including unexpected-yet-possible side effects that might occur (such as but not limited to nerve damage or death) – that may be related to my pet’s age and health status prior to treatment as well as my pet’s prior underlying health issues.
If my pet is not responding as expected and could benefit from other forms of traditional or alternative medicine, I am aware that Dr. Schepps may offer other forms of treatment or refer me back to my regular veterinarian, to a board-certified specialist or to a different alternative medical provider.
I understand that, as with all veterinary medical and holistic healthcare approaches, results are not guaranteed, and there has been no promise by Dr. Schepps to completely cure my pet.
I recognize that acupuncture and laser therapy are considered different forms of complementary and alternative veterinary medicine and that other, more conventional treatment options, are available to me/my pet from clinical practitioners. I am aware that these clinical treatment options may include, but are not limited to: veterinary medical care with prescription drugs (such as pain relievers or muscle relaxants), ongoing physical therapy, braces or splints, cortisone injections, surgery, limited movements/rest, or no treatment at all.
I agree with, and give consent for, Dr. Schepps to provide acupuncture and/or laser therapy treatment of my pet, as well as other services or products that she deems will help my pet. In providing this consent, I shall also hold Dr. Schepps, Schepps LLC and d/b/a Wellness Waggin’, harmless from, and against, any and all claims of liabilities for damages or claimed damages of my pet that might arise – whether directly or indirectly – as a result of, or following, her providing services, care and treatments on my pet. I am aware that the practice of veterinary medicine is not an exact science and, thus, no guarantee for successful treatment has been made for my pet. I hereby consent to the procedures of acupuncture (or, if applicable, to laser therapy) by the attending doctor. In the absence of gross negligence, I agree to hold Dr. Schepps harmless for the absence of response to treatment or any ill effects experienced by my pet.
I intend for my consent to cover the entire course of treatment (of acupuncture or of laser therapy) for my pet’s present condition and for any future health condition(s) that my pet might acquire for which I seek further or additional treatment(s) from Dr. Schepps. I also understand that I can terminate additional sessions for treatment at any time.
By checking the box and signing below, I confirm that I have read, or have verbally discussed, about the risks and benefits of acupuncture, the risks and benefits of cold laser therapy, as well as the potential benefits of other procedures and products related to my pet’s ailments, and have had an opportunity to have my questions answered to my satisfaction PRIOR TO signing.

New Patient Forms

Section 1: Client/Patient Information

Client (Pet Parent) Information

Section 2: Informed Consent and Treatment Agreement