Rehabilitation

We look forward to helping you and your pet with integrative veterinary care.
Please complete the Rehabilitation Assessment Form below.

Rehabilitation Assessment

We are so happy to meet you! We just need some information to get started. We look forward to helping you and your pet with integrative veterinary care.

For currently active patients only.

"*" indicates required fields

Name*
Please tell us your preference for treatment of your pet(s)*
How much information do you want to be given about your pet's visit?*
Is your pet food motivated?*
Are there other pets in the house?*
Is your pet aggressive towards: (select all that apply)
Have there been any significant medical issues in the past (i.e. surgeries, accidents, vaccine reactions, noise phobias (e.g. vacuum), separation anxiety, etc.)? **
Have there been any signs of:*
What time of the day (if any) do you notice discomfort, stiffness or soreness in your pet:*
Any changes in attitude/temperament?*
Have there been any changes in the household recently?*

Functional Abilities

Able to position to urinate and defecate*
Able to change position from lying and sitting or vice versa*
Able to change position from sitting and standing or vice versa*
Able to lay his/her side then change position*
Able to scratch behind ears*
Able to stretch while standing or laying*
Able to negotiate the flooring throughout the home*
Able to get in and out of the home*
Able to get on/off the couch or bed*
Able to get in/out of the car*
Able to go up stairs*
Able to go down stairs*
Able to run*
Able to jump*
Able to stand while eating*
Please indicate where you are noticing lameness or soreness or where lumps/masses are present on your pet.*

(Optional: you can use the following diagram and mark it on the diagram digitally and upload it for us if you are able to do so)
Click here to view the diagram.

Max. file size: 50 MB.
That's it! Thank you for being patient and filling out the details. We can't wait to meet you!
This field is for validation purposes and should be left unchanged.