First Name
Last Name
Mobile Number
Home Number
Email Address
Street Address
City
Province
Postal Code
Emergency Contact
Name
Breed
Sex —Please choose an option—MaleFemale
Neutered/Spayed —Please choose an option—YesNo
Weight
Date of Birth (mm/dd/yy)
Approximate Age
Regular Veterinary Clinic
Dog’s Sport/Activity
Owner Goals
Previous Injury
Explain in Detail
Current Supplements & Medication (product name, brand, dose, frequency)
Food Allergies
Current Exercises and/or Activity Level?
Performance Goals
Any Specific Concerns?
What Balance and Stability Equipment do you own?
Do you have any physical limitations that I should be aware of? (bad back/knees, etc)
Does your dog know targeting skills on cue? (front foot target, rear foot target, chin rest, nose touch, etc)
What method of dog training do you subscribe to?
Please let us know your dog’s demeanor/behaviour
You can opt to receive emails to remind you of your appointments, receive your receipts and invoices, etc. —Please choose an option—YesNo
Stretch and Fetch Rehabilitation Inc. has disclosed to me the nature of holistic and complementary therapies and rehabilitative medicine.
I authorize Stretch and Fetch Rehabilitation Inc. to use the recommended rehabilitative and complementary treatments on my pet.
I understand that Stretch and Fetch Rehabilitation Inc. recommendations and treatments of my pet constitute no guarantee of results. I further understand that Stretch and Fetch Rehabilitation Inc. recommendations and treatment are based, to some degree, on the information that I supply.
In consideration of the foregoing, I waive and release any and all rights, claims, and causes of action I have or may have against Stretch and Fetch Rehabilitation Inc. and its affiliates, officers, directors, employees, representatives, successors and assigns, that may arise as a result of any of Stretch and Fetch Rehabilitation Inc. recommendations or treatment of my pet, including, but not limited to any laser therapy, therapeutic exercise, massage or other treatments or care.
I Agree*
We request that in situations requiring appointment cancellation that we receive at least 24 hours notice. This allows us to provide that appointment time to another pet in need.
Cancellations made within 24 hours will be subject to a $32+tax charge.
No show, no call appointments or appointments cancelled within 1 hour are subject to a charge of 100% the cost of the appointment or the loss of an appointment if there is a prepaid package.
Appointments for late arrivals will be shortened to meet the scheduled completion time unless time is available to enable an extension.
Appointments arriving more than 10 minutes late may need to be rescheduled to avoid disrupting the appointments of other patients.
We understand that emergencies arise and appreciate you keeping us informed of unforeseen circumstances.
Payment is due in the form of cash, debit, e-transfer, Mastercard or visa. All services purchased are non-refundable, but packages can be transferred to another pet in the event of death.
Any retail items purchased are 100% refundable within 30 days if the product is unopened and unused.
Pets must be clean, well groomed and parasite free, with no signs of fleas, ringworm, mange, or contagious diseases before coming to Stretch and Fetch Rehabilitation Inc. for treatment. We reserve the right to refuse pets based on these criteria.
All pets must be restrained by a leash or placed in a kennel or carrier prior to entering the facility and must remain so while in our facility unless being treated by a practitioner. This is for your pet’s safety and the safety of other pets and clients.
Rehabilitation and facility equipment is to be used only by or under the supervision of the staff in caring for our patients. Do not attempt to use, climb, jump, or balance on any of the rehabilitation or clinic equipment you may encounter during your visit.
Do not enter another treatment room, rehabilitation therapy room, or other room in the center unless escorted by a staff member.
Stretch and Fetch Rehabilitation Inc. often records photographs and videos of patients while at the clinic for the purposes of education, promotion, or advertising.
Please select one of the following options: * I authorize the use of my pet’s image or likeness for these purposes.I do not authorize the use of my pet’s image or likeness for these purposes.
Stretch & Fetch Rehabilitation Inc. operates as a curbside facility.
This means that you will check in via text, phone call, or social media message.
The practitioner will come to your car and discuss any updates with your pet before bringing the pet into the building for treatment. Due to the small space we have and amount of equipment we use, owners are not permitted to come into the treatment room.
Following the appointment your practitioner will bring your pet back out to the vehicle, discuss the appointment with you and take payment if necessary.
If you have a third party bringing your pet to their appointment please send a quick update via email prior to the appointment and your practitioner will email you back after the appointment.
Please type your full name below to confirm that all information in this intake form is true to the best of your knowledge and, to confirm that you understand all of the authorizations and waivers included in this intake form.*