Healing From The Earth

Vets Referral Form

This is a printable page just select the print option from your browser tool bar.

Pets Details (to be filled in by the owner)
Pets Name	Colour
Breed	Date of Birth
Owners Name	Signature
Address
Phone Number
E Mail:
Insurance co.	Policy Number

Veterinary Details
Name
Address
Phone	Fax
E mail:

Current Health & Medical Conditions. (To be filled in by the Vet)

Current Vaccination and Medication Details. (To be filled in by the Vet)
In my opinion this animal is fit for Therapy	Yes	No

Any Special Considerations Before Treatment

Vets Signature & Stamp (Please sign and print your name)

Please either fax this form to 0865 288227, give it to the client to bring along with them when they come for the initial assessment or post to Healing From The Earth 53 Lanercost Cr, Monkston Milton Keynes MK10 9EA Email animalenq@hfte.co.uk Tel:07969086323

The Veterinary Surgery Act of 1966 prohibits anyone other than a qualified veterinary surgeon from diagnosing ailments in animals. However the healing of animals by contact healing, by the laying of hands or distant healing is legal and Reiki comes within this description.