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Rehabilitation Form
Help us get to know you and your pet!

Client Info

(Home exercises and progress notes will be sent through email)

Preferred Method of Contact

Patient Info

I give permission for my pet to be photographed and/or videoed for any lawful purposes, including publicity, illustration, advertising and website content.

Patient History

If there are food allergies, please bring in a small bag of their food to be used as treats. 

What do you feed your pet?
Please select all that apply to your pets tempermant.
Working dog?
Activity Level

(ie. house pet / agility / sporting dog; what outcomes would you like to see from rehabilitation etc.)

(ie. injury / illness that limits ability to do at home exercises; time conflicts etc..)

Activities of Daily Living 

Please rank the below activities based on the following scale:
0 = unable to preform,
1 = needs moderate assistance,
2 = needs minimal assistance,
3 = able to perform independently 

Please only feed 1/2 of the normal amount of food the day of rehabilitation and bring the rest to be used as treats.

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