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VSMT Referral Form

**Please Only Submit if You Are a Referring Veterinarian**

Thank you for trusting us with your patients' for Veterinary Spinal Manipulation Therapy! Please email all radiographs and medical/ vaccine records to If unable to email records, please send a physical copy with the owner to the Initial VSMT evaluation appointment.

Diagnostic Data Accompanying Referral (send to
Any Concurrent Illnesses that Impact VSMT

Thanks for submitting!

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