Veterinary Consent Form

Legally Physiotherapists cannot assess or treat an animal unless we have permission from the animals registered Veterinary Surgeon (Veterinary Surgeon’s Act, 1966).

​At ECH Physiotherapy we require written consent from the treating vet to ensure we have an accurate history/ diagnosis, and for legality. The form can be found below, if you wish to refer your client to me directly, please complete the form.  Alternatively, you can ask your clients to contact me, and I can send you a copy of the form to fill out. ​

Thank you for your support and referrals.

Owners Details

Contact Numbers

Animal Details

Referring Veterinarian


I consent that the above animal attends for a physiotherapy assessment and any such treatment deemed appropriate by the Veterinary Physiotherapist, Emma Smith. I understand that, in giving this consent, I am not responsible for any physiotherapy assessment or treatment given or undertaken by Emma Smith. I also am aware that the provision of professional indemnity insurance for Veterinary Physiotherapy treatment is the sole responsibility of Emma Smith.