Make A Case with Companion 2014/2015

Make A Case with Companion 2014/2015

Win Your Choice of 3 Amazing Grand Prizes!
1. CE at Sea Cruise for 4, April 2015
2. Trip to NAVC for 4, January 2016
3. Trip to WVC for 4, February 2016

Fill out the form below OR download a Word version of the submission form at http://www.litecureinfo.com/MakeACaseSubmissionForm

This year the Make a Case with Companion Contest will focus on cases that have changed lives. Changed the lives of pets, the lives of owners, or the lives of you and your staff.

Cases with high impact results, complete clinical information, supporting video and photo assets and "life changing" testimonials will perform the best! Thank you for your submission!

If you have files that are too large to attach via this form (videos are too large to attach) please send them to amandah@litecure.com via www.WeTransfer.com, in the message please include your name, clinic name and email address and the submission will be added to your record!

Submissions will be accepted until February 18, 2015, and clinics are welcome to submit as many entries as they like.

Case Submission Information
Case Submission Contact Full Name *
Email Address of Contact *
Name of Supervising Veterinarian *
Veterinary Clinic Name *
Clinic Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Will You Be Providing Supporting Photos? * Yes No
Will You Be Providing Supporting Videos? Yes No
Patient Information
Patient Name *
Patient Age & Gender *
Patient Species & Breed *
Patient's Symptoms *

Include location and associated symptoms.
Medical History *

Include current and past diagnoses, medications, etc.
Initial Assessment *

Provide results of any initial tests
Initial Diagnosis *

Provide the initial diagnosis
Treatment Information
Laser Used For Treatment * CTL-3 CTL-6 CTL-9 CTL-10 PTL CTC CTS PTC Other
Frequency of Treatment *

Enter how often treatments were applied and time between treatments.
Protocol Used (If Any)

Enter built-in protocol used and/or patient characteristics (skin color, body type)
Mode

Enter CW or frequency (Hz) used to administer treatment
Power *

Enter power setting in Watts (W)
Treatment Time *

Enter the duration(s) of each laser treatment session
Total Energy Delivered (= Power x Time) *

Enter the total energy (Joules) delivered during treatment
Areas Treated *

Enter body part locations of treatment
Approximate Size of Treated Area (in cm2)

Enter the size of the area treated in cm2
Other Treatment Details

Enter details about the treatment head used and the distance held from the skin and any other details about the treatment
Any Other Treatments Used

Enter any other treatment techniques, approaches or protocols used
Assessment Used

Enter assessments, functional and quantitative measures are best
Results
Discuss patient response to treatment. Explain any correlations or inconsistencies. Attach relevant images, tables or graphs below. *
Files Associated with Results
Testimonial
How did this make a difference in someone's life? Attach relevant testimonials from pet owners who were positively impacted by the treatment, or from a staff memeber or veterinarian who had a life changing experience below.
File Associated with Testimonial
Discussion
Include information/ applicability to other conditons if appropriate.
References
Comments