|
|
Lameness and Gait Analysis of the Dog
e-mail questions to CAVGA@sportsvet.com
Client Information and Patient History
Form
Information attained from Computer Assisted Video (CAV) Gait
Analysis can be used by Veterinarians or Dog Owners to help diagnose obscure
lameness or assess performance in the dog. SportsVet.com is now providing
this service. The cost for an analysis and report is $75.00
USD. Please see the CAV-GA information page to view a sample report.
We accept credit card payments through Sports Medicine Veterinary Supplies
or we can accept a check or money order. The analysis and report
will be completed 1-3 days after we attain the videotape. For requests
being paid by check the report will be completed 1-3 days after the check
has cleared. The report will be sent out by e-mail and a copy will
be mailed to the address listed in the information.
Simply e-mail the following information to CAVGA@sportsvet.com or it
can be included with the mailed-in videdotape. Print a copy of this
form using the print method of your browser, and answer the questions.
It is required that all questions be answered for an analysis to be performed.
If more space is needed to answer questions feel free to answer the questions
on a separate page. The agreement at the bottom of this page must
be read and signed by the owner or designated handler. The signed
copy of this form must be included with the videotape
Client Information
Client Name:
Address:
City, State, Zip code:
E-Mail Address:
Designate Type of Communication (Mail or E-Mail):
Camera Type (name, model, type, etc.):
Filming method, i.e. used VHS camera at 100 fps or other method:
Measuring Stick, i.e. yardstick, meterstick, etc.:
Pathway Description:
Film Site Description:
Patient Information
Pet's Name:
Breed:
Date of Birth:
Sex:
Spayed or Neutered:
Color and Markings:
Types of activity your dog performs:
What do you want to know from our gait analysis?
Medical History
General Medical History
Vaccination Regimen:
Current Medication:
Past Injuries:
Past Medical Problems:
Specific Medical History
Skin:
Musculoskeltal:
Circulatory:
Respiratory:
Digestive:
Urinary:
Eyes:
Ears:
Neural:
Dental:
Agreement
The information provided by this service is designed
for educational purposes only, and is provided with the understanding that
Robert L. Gillette is not rendering veterinary medical or professional
medical services or advice. By requesting this service I agree that
I hold Dr. Robert L. Gillette harmless from any loss, claim or damage arising
from your use of any of the information and ideas contained and presented
at this site. By signing this form I state that I am the owner/handler
of the patient. I understand that the tape that I send will not be
returned to me.
Signature________________________________________ Date____________
e-mail questions to CAVGA@sportsvet.com
Return
to the top of the page. |
The following ads are
placed here through Google Adsense and are not necessarily endorsed by
Dr. Gillette.
|
