Veterinary consent form
Lynn Rushton Dip EThPK

Equine Massage Therapist
Fully qualified & insured

Dear Sir/Madam
I wish to seek approval for massage therapy on the animal named below.

Owner:
Address


Post code
telephone number

___________________________________________
Equine name
Age
Breed
Sex
Address stabled at

I am the legal owner of the above named animal
Signed
___________________________________________
This section should be completed by your veterinary surgeon.

Veterinary surgeon
Practice Address
& stamp

Telephone number

Any medical history which might be affected by massage therapy / or areas of caution/ comments / medication if any.




In your opinion is the above named animal in a suitable state of health to undergo massage therapy. yes/no


Veterinary signature
date


Thankyou for your time, kind regards, Lynn Rushton