Referral form with veterinary consent to participate in physical rehabilitation at Stretch and Fetch Rehab.
Clinic Name *
Consenting Veterinarian *
Contact Number *
Full Name *
Brief History of Problem
Other Relevant Information
Comprehensive Rehabilitation Consultation with Janelle Merritt, DVM and rehab practitioner, Marissa DuBois, RVT, CCRP;Rehabilitation (may include laser therapy, electrical muscle stimulation, therapeutic exercise, massage); *Non-Complicated Post Surgical Rehabilitation; **Weight Loss Program;Osteoarthritis Management;Laser Therapy;Home Exercise Plan & Lifestyle Management.
* Must accompany a rehab consultation unless listed below.
** Rehab consultation not required.
Is a recheck required from the regular DVM to continue rehab?
If yes, please provide the date a recheck is required.
I would like Stretch & Fetch brochures sent to my clinic;I would like to book a rehab information session for my clinic with Marissa DuBois, RVT, CCRP.