Canine Consent Form

Please fill out the following form.

Full Name

Address

Phone

Email

Animal Name

Sex

Age

Breed

Registered Veterinary Practice

Is your dog involved in any sporting activities

No - House hold pet

Yes

If yes please specify

Daily activity level - Walked per day & for how long

Has your dog ever shown any signs of aggression & is there anywhere they do not like to be touched?

I am happy to allow photos of my animal to be taken and used for social media and advertising purposes.

Yes

No

By completing this form, you consent to physiotherapy treatment for the dog named above by McMasters Veterinary Physiotherapy."

Signature

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Date

Canine Owner Consent Form