Rehabilitation Registration

Owner's name:

Preferred method of communication:

Pet's name:

Breed:

Age:

Activity Information

Activity Level before Injury: Describe the pet's typical activities (e.g., walks, runs, plays fetch) and duration before the injury.

Current Activity Level after Injury: Describe any limitations or changes in the pet's activity due to the injury.

Rehabilitation Goals: What specific improvements or outcomes are you hoping to achieve through rehabilitation? (e.g., improved mobility, pain relief, ability to participate in specific activities)

Health Information

Medications: List any medications/supplements your pet is currently taking, including dosage and frequency.

Does anyone in your home have an allergy to any of the above if fed to your pet?

Home Environment

Additional Information about Home: Environmental factors that may affect your pet's rehabilitation. (e.g. Staircases, access to outdoor areas, multi-level, ramps, other pets)

Behavior and Routine

Daily Routine: Frequency of walks, bathroom breaks, and exercise.

Behavioral Considerations: Are there any behavioral issues or concerns that may affect the rehabilitation process? (e.g., fear/anxiety, dislike of water, fear of men/women, dislike or feet being touched, etc.)

Additional Comments or Concerns:

Is there any other information you believe would be important for the rehab therapist to know about your pet?

Pet Owners

Rehabilitation Therapy form

Activity Information

Health Information

Home Environment

Behavior and Routine

Additional Comments or Concerns: