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Sex of animal:
What type of referral is this?
Diagnosis and pertinent medical history of condition afflicting the above mentioned patient:
Surgical and/or other procedures performed and dates(s):
Current medications and nutraceuticals:
Any contraindications of rehabilitation therapy to the above-mentioned patient?:
Relevant Documents and Radiographs (Required)
MANDATORY: Please include medical records and radiographs with your submission. This can be sent in a separate email.
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