Rehabilitation Initial Exam Questionnaire

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Rehabilitation Initial Exam Questionnaire

Name *

First

Last

Email *

Phone *

Pet's Name *

What is your main treatment goal for your pet’s rehabilitation appointment? *

What is your pet’s current daily exercise routine? *

Has there been any recent change to exercise and activity level? *

Does your pet have a current or previous history of mobility issues (such as intermittent limping, arthritis, surgeries, etc.)? If yes, please explain. *

What flooring is in your home (hardwood, area rugs, carpet, etc)? *

Does your pet slip or slide in your home? *

Are there any stairs in your home? *

Does your pet have trouble going up and down stairs? *

home? have (hardwood,

What is your pet’s diet? How often do they eat? *

Does your pet get treats? What kind? *

What current supplements do you give your pet (brand name, strength, frequency)? *

What are your pet’s current prescription medications (name, strength, frequency)? *

Have you recently stopped a prescription medication or a supplement? Why? *

Does your pet have sensitivities to any medications or supplements? *

Does your pet have any food or gastrointestinal sensitivities? Any treats we should avoid? *

Does your pet have any history of cancer? *

Does your pet have any history of seizures? *

Does your pet have any history of nipping or biting a person or other animal? *

Has your pet ever needed to be muzzled or sedated due to behavior for a vet appointment? *

Does your pet prefer sunny/warm areas or cool/shady areas? *

Rehabilitation Initial Exam Questionnaire

Rehabilitation Initial Exam Questionnaire

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