We are expanding our services and adding an UWT. Past blogs gave me some great info on how to design the structure of room, visits, etc. One thing I am struggling with is wording on a clearance form from a rdvm. Initially we would like to authorize patients coming from other hospitals but are requiring healthy animals have a clearance from their vet. Does anyone have something they would be willing to share?
Thank you,
Missi
Forms
Re: Forms
Hi Missi,
We have JUST created something similar. We have a proper referral / request for medical information for rehab cases... but this is the one we have created to catch the 'others'. I hope I can cut and paste it here:
Aquatic Exercise Clearance Form
Please note that this is not a referral, consent to treat, or request for medical information.
This is veterinary clearance, so as to allow _______________________________________
to engage in an aquatic exercise program.
Client Information:
Name: _______________________________________________________________________
Phone Number: _______________________________________________________________
Pet Information:
Name: _____________________________________ Age: ________________________
Breed: ______________________________________ Gender (circle): M F MN FS
Special Considerations: __________________________________________________________
____________________________________________________________________________________________________________________________________________________________
Services Approved (please check):
O Under Water Treadmill O Resistance Pool O Physio therapy services (if required)
Veterinarian Name: _____________________________________________________________
Clinic: ________________________________________________________________________
Signature:_____________________________________________________________________
Date: _________________________________________________________________________
I hope this helps!
Cheers,
Laurie
We have JUST created something similar. We have a proper referral / request for medical information for rehab cases... but this is the one we have created to catch the 'others'. I hope I can cut and paste it here:
Aquatic Exercise Clearance Form
Please note that this is not a referral, consent to treat, or request for medical information.
This is veterinary clearance, so as to allow _______________________________________
to engage in an aquatic exercise program.
Client Information:
Name: _______________________________________________________________________
Phone Number: _______________________________________________________________
Pet Information:
Name: _____________________________________ Age: ________________________
Breed: ______________________________________ Gender (circle): M F MN FS
Special Considerations: __________________________________________________________
____________________________________________________________________________________________________________________________________________________________
Services Approved (please check):
O Under Water Treadmill O Resistance Pool O Physio therapy services (if required)
Veterinarian Name: _____________________________________________________________
Clinic: ________________________________________________________________________
Signature:_____________________________________________________________________
Date: _________________________________________________________________________
I hope this helps!
Cheers,
Laurie
LAURIE EDGE-HUGHES
-
niagaracanine
- Posts: 1
- Joined: Mon Sep 26, 2016 3:36 pm
Re: Forms
Hi Missi,
We have a swimming pool at our facility. For all our rehab cases we require a vet referral and will have completed a thorough rehab assessment prior to treatment which could include the hydrotherapy. However we do have clients bringing their dogs for swimming for fun and fitness which don't require a vet referral. What we insist on is a pre-swim check. We have the owners do a health questionnaire, we check heart lungs, skin and joints and take a medical history and make sure there are no bowel or bladder issues. This usually take about 15 mins and we charge $25 for that.
Barbara
We have a swimming pool at our facility. For all our rehab cases we require a vet referral and will have completed a thorough rehab assessment prior to treatment which could include the hydrotherapy. However we do have clients bringing their dogs for swimming for fun and fitness which don't require a vet referral. What we insist on is a pre-swim check. We have the owners do a health questionnaire, we check heart lungs, skin and joints and take a medical history and make sure there are no bowel or bladder issues. This usually take about 15 mins and we charge $25 for that.
Barbara