Physical Rehabilitation Intake Form Physical Rehabilitation Intake Form We are excited to see your pet for their initial rehab consult! Please fill out this form at least 24 hours prior to their initial appointment. By doing so, this will allow us more time at your visit to discuss any recommended rehab program, go over initial exercises, and answer questions. Some questions are marked as required. Others are optional but the more information we have, the better we will be able to tailor the rehab program to your pet's individual needs. If your pet has had diagnostics or treatments for the presenting problem at hospitals other than Canobie Lake Veterinary Hospital, please make sure to request that they send all relevant records (including x-rays and labwork) to us. If we have not received records at least 24hours in advance of the appointment, we will contact you to reschedule your appointment to a later date to allow time for these to be reviewed prior. Name * First Last * Last Best contact phone number * Email * Your pet's name * Breed Age Pet weight (if known) Gender Male - not neutered Male - neutered Female - not spayed Female - spayed If you are human, leave this field blank. Next
