Dr.
Date:
Client Name:
Requested a consultation at our facility for their canine companion:

This would include: a rehabilitation evaluation, home exercise program and hydrotherapy.

Our facility provides canine rehabilitation, hydrotherapy and fitness programs as an adjunct to high quality veterinary care. Therefore, a rehabilitation evaluation, suggested exercise program and hydrotherapy is only provided when working in conjunction with a referring veterinarian. We believe this collaborative relationship is essential to attain high quality outcomes.

Please complete the following information so we can offer the best possible care. If you do not recommend these services, please do not complete the form, but contact us by phone at your earliest convenience so we may notify the client.

Information

1. Veterinarian Diagnosis or Impression of the Problem:
2. If there are recent tests or procedures that you think may be helpful please comment or fax/send any pertinent information:
3. Please feel free to recommend or suggest any additional rehabilitation modalities or treatments you believe may be helpful to this client:
I am referring this client for a rehabilitation evaluation, home exercise program and hydrotherapy.
Submit

ISN'T IT TIME FOR YOUR DOG TO FEEL LIKE A DOG AGAIN?