Pawrental Consent Form

Please complete this form when you have made an appointment with us.

All dogs require a veterinary referral.  This ensures hydrotherapy is safe and appropriate.

• If you have a referral, book directly.
• If not, we can guide you on how to obtain one.
• We work in partnership with your vet and can provide progress updates upon request.

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Owners Name *

First

Last

Email *

Mobile Number *

Pets Name *

Sex of Dog *Male DesexedMale IntactFemale DesexedFemale Intact

Breed *

Age *

What motivates your Dog?

• Treats
• Toys
• Ball
• Other

This helps us keep the dog engaged during the treatment.

Other (please explain what else motivates your dog if necessary)

Is your dog on any medications/supplements? *

Please explain in detail

Is our Dog Ambulant? *

• Ambulant
• Non-Ambulant

Do you have insurance? *

• Yes
• No

If so, who with?

Vets Practice Name

Vets Name

Vets Phone Number

Vets Email Address

Summary of Pets Condition/Injury and areas of caution

Please put as much detail as you can, this will help us complete the correct treatment

What is your goal for your pet after your treatments?

Anything else we should know?

Preferred Contact *PhoneEmailText

How would you like us to contact you?

Please ensure to email your vet referral *

• I have emailed to [email protected]

Send to us!