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The Mission
The Story
The Dogs
Home
About
The Mission
The Story
The Dogs
Services
Rates
Contact
Intake Form
Pay
Animal's Name
*
First Name
Last Name
Weight
Age
Type
Breed
Sex
Spayed/Neutered
Yes
No
Animal's Person
*
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Emergency Contact
Veterinarian (Name and Number)
Where did you obtain your animal companion, and at what age did they join your family?
Describe any other animal companions in the home, if any. What is their relationship?
Does your animal companion live indoors or outdoors?
Please describe any current injuries or medical conditions.
Current medications?
Allergies or skin conditions?
Location of pain/discomfort?
What are you looking to achieve?
Has your animal companion received a massage before, and if so, when and for what purpose?
Is the animal sensitive to touch or pressure in any areas, if so, where?
Please list any history of behavioral, aggressive, reactive behavior, if any.
What do you feed your animal companion?
Feeding schedule?
Exercise schedule?
Date of last ear check?
Date of last nail trim?
Date of last teeth cleaning?
Please describe any prior surgeries, illnesses, and medications.
Immunizations?
Is there anything else that I should know about your animal companion?
What are his or her likes, dislikes in terms of touch, food, toys, noise, etc.?
By checking this box I acknowledge that massage does not take the place of proper veterinary care from a doctor of veterinary medicine. Please contact your local veterinarian for any persistent problems bothering your animal companion.
*
Thank you so much! I’ll be in contact with you shortly.
