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Veterinary Consent Form
Referral form with veterinary consent to participate in physical rehabilitation at Stretch and Fetch Rehab.
Consenting Veterinarian Information
Brief History of Problem
Other Relevant Information
Stretch & Fetch Services Requested
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
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
Please upload additional medical records and radiographs.
Drop files here or
Max. file size: 32 MB, Max. files: 5.
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