I would like my pet treated at the above named facility (the facility). In support of that treatment I state the
1) I am aware there may or may not be a veterinarian on site. My veterinarian is aware that I am pursuing rehabilitation, hydrotherapy, and/or a swimming exercise program for my pet and has cleared my pet for such activities.
2) I acknowledge that a person trained in canine rehabilitation has discussed treatment with me and has
advised me of the risks and contraindications associated with the treatment of my pet. I have read the
attached materials given to me on the subject by the facility.
3) I have provided the facility with a complete and accurate medical history including details of the present
injuries and illnesses of my pet.
4) I understand that rehabilitation and hydrotherapy in dogs is an evolving field and scientific evidence to
measure effectiveness is currently limited.
5) I understand the nature and purpose of rehabilitation, hydrotherapy, and/or swimming/fitness programs and
that such treatment may not accomplish the desired objective.
6) Any rehabilitation equipment provided by the facility is for the sole purpose of use with my pet, and is not
for human use. I understand that said equipment is utilized for my pet at my own risk.
7) I understand that in some instances, certain conditions can be exacerbated or worsened by rehabilitation
and/or hydrotherapy. I am aware that there are serious and potentially fatal risks associated with
hydrotherapy, rehabilitation, and some of the exercise programs.
8) I have been advised of the risks of hydrotherapy, including but not limited to the risks of animal bites, equipment, accidents, or injuries. I have read the material entitled Benefits and Risks of Rehabilitation and Hydrotherapy that is on the back of this page and have had the opportunity to ask questions concerning it.
IMPORTANT – The aforementioned list of contraindications is not exhaustive and there may be other conditions identified by your veterinarian that would prevent treatment. This is one reason we require veterinary pre-authorization for any rehabilitation, hydrotherapy or fitness / swimming program.
UNDERSTANDING ALL THE ABOVE, I HEREBY AUTHORIZE THERAPISTS AT THE FACILITY AND ANY ASSISTANTS SELECTED OR SUPERVISED BY THEM TO PROVIDE REHABILITATION AND/OR HYDROTHERAPY FOR MY PET.
On behalf of myself, my heirs, personal representatives and executors, I expressly agree to hold harmless and release the facility and its employees, officers, and agents from ANY AND ALL responsibility, liability, claims, causes of action, or demands of any nature and cause, including costs and attorneys’ fees.