CLIENT INTAKE FORM

Dog's Name

Dog's Date of Birth

Owner's First Name

Owner's Last Name

Street

Suburb

Postcode

Email Address

Phone

Breed

Sex SexMaleFemale

Desexed Yes/No Desexed Yes/NoYesNo

If yes, what age?

How did you find out about our services? How did you find out about our services?Google MapsGoogle SearchFacebookInstagramWord of MouthReferralCar Signage

If you found us through Google Search would you mind sharing which words you typed into google, otherwise enter n/a

If you were referred to us please provide their name, otherwise enter n/a

What is your dog's activity level? What is your dog's activity level?LowMediumHigh

What walking restraint are you using? What walking restraint are you using?CollarHarnessHaltiMostly Off Lead

How often do you walk your dog and for how long?

Is your dog involved in any sport (i.e. agility, confirmation, scent work, tracking, etc)?

Where does your dog sleep (i.e. inside/outside, kennel/crate, bed, couch, etc)?

Diet/Nutrition (i.e. dry food, wet food, raw feeding, combination, etc.)?

Vet name and address

Last vet visit

Current medication administered

Current supplements administered

Please tell us your reason for engaging Paws4Paws

Please tell us about any injuries and/or medical conditions your dog has had in the past and/or currently has (i.e. arthritis, hip/elbow dysplasia, spondylosis, lumbosacral disease, IVDD, cruciate ligament injury, tendonitis, muscle strain, luxating patella, etc.).

Does your dog have any difficulties lying on their front, back or side? Does your dog have difficulties/is reluctant/hesitant to jump in/out of a car, or climb/descend stairs? If so, please provide further detail.

Has your dog’s behaviour changed in any way (i.e. less social, less playful, anti-social, aggressive, lethargic, etc.). If so, please provide further detail.

Is there any particular area where you think your dog is experiencing stiffness; tension; discomfort or pain? If so, please provide further detail.

Do you feel your dog is currently under stress? If so, please provide further detail.

Is there anything else about your dog’s health and/or behaviour that would be useful for our therapist to know?

Client Consent Client Consent I understand that the service provided by Paws4Paws is the assessment, treatment and rehabilitation of musculoskeletal pain and associated conditions. I am aware that Paws4Paws does not diagnose illness or disease and does not prescribe medication. I have informed Paws4Paws of all known physical and medical conditions of my dog, as well as any medication administered (including herbal remedies and supplements), and will keep Paws4Paws updated on any changes that occur.

Cancellation Policy and Late Payment Fees Cancellation Policy and Late Payment Fees Due to the nature of our business structure of providing in-home therapy, we require that you call at least 24h in advance if you need to reschedule or cancel an appointment. Any reschedule or cancellation made less than 24h in advance will incur a fee of $70. Late payment fees apply for invoices that are more than two weeks overdue.