Forms - Therapeutic Techniques for Animals

Pet Guardian's Name *

Address *

Phone Number *

Email *

Animal's Name *

Dog/Cat/Other *

Breed *

Age *

Male/Female *

Desexed *

Yes
No

Level of Daily Activity

High
Medium
Low

Name of Veterinarian *

Veterinarian Phone no.

Medications/Supplements taken *

Indicate any conditions and/or surgeries past or present *

Any behavioural issues (fear, anxiety, hyperactive, timid, etc.) *

Is there any area where you believe your animal is experiencing discomfort, stiffness, pain? *

Is there anywhere your animal doesn’t like being touched? (paws, head, back etc.) *

Has your animal had massage therapy before?

Yes
No

Do you give permission for your animal’s photo session to be used in social media? (Facebook and Website)

Yes
No

I have listed all of my animal’s known health conditions and I agree to inform Therapeutic Techniques for Animals of any changes in my animal’s health between massage sessions. I understand that the massage and bodywork provider must be made aware of any and all health conditions to provide safe and effective massage. I understand that if my animal suffers from certain conditions, Therapeutic Techniques for Animals will require veterinarian approval for massage and bodywork to be carried out. I understand that massage therapy is not a substitute for veterinary care and that the massage and bodywork provider does not diagnose nor prescribe for injury, illness or any other physical disorder, nor does the massage and bodywork provider treat any medical condition in animals. I agree to give 12 hours’ notice to cancel an appointment and that failure to do so will result in the full fee being payable.

Agree
Disagree