Canine Intake Form For Owners

We would greatly appreciate it if you could take 15 minutes to complete this form. Please provide as much detail as possible about your dog below before their initial consult at CS Hydro Physio. This information will assist our team in tailoring a treatment plan specific to your dog’s needs and allow for more time during your consultation for introduction to hydrotherapy and physiotherapy equipment and techniques.

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Owner Name

Pet Details

Medical History

Please let us know why you are bringing your dog to CS Hydro Physio in detail, as well as any other medical history your dog has had from an ear infection to lameness and surgeries.
Please describe in detail the reason you are bring your dog to hydro-physio. Include medical condition(s) (i.e. hip dysplasia, arthritis, muscle loss etc..), as well as time frames, surgeries undergone ect...
Does Your Dog Have Any Of The Following Conditions or Concerns?
Does Your Dog Have Any Skin Or Food Allergies, Intolerances Or Concerns?
Is Your Dog On Any Medication?
Please inform us of any other veterinary visits your dog has had throughout their life, including ear infections, stomach problems, allergies, lameness, etc. This information is crucial for assessing your dog's overall health. If possible, provide approximate dates or ages for these occurrences.
Has Your Dog Previously Received Hydrotherapy or Physiotherapy Treatment At Another Clinic?
We may like to request previous treatment notes if your dog has seen a different therapist.
Click or drag files to this area to upload. You can upload up to 10 files.
Please attach any documents you have received from vets, previous therapists or anyone else you feel relevant.

Early Life

Please provide us with information about your dog's early life. The more details the merrier. This information assists us in building a comprehensive understanding of your dog's overall health, potential causes of any health concerns observed, or underlying conditions they may have. *If you have a rescue dog, some of the questions in this section may not apply to you.
Have You Had Your Dog Since A Puppy?
If your unsure as your dogs is a rescue please state that and make a rough estimate
Did they settle in well? Any memorable concerns?

Exercise Levels

What has your dog previously achieved? How many walks a day? How long for? And how far? How much on and off lead did they do? Did your dog do much in the way of ball throwing or playing with toys? Does your dog usually take part in any sports or activities (i.e. agility, gun dogs, sent work)
What exercise is your dog currently doing? Has it changed or been reduced? Have you been given instructions by the vet regarding rest, walking, and progression?
Ideally, what level of exercise would you like your dog to return to?

Diet & Behaviour

This information is to help us prepare for meeting you and your dog in the most positive way for them
What type (wet, dry, raw) and brand of food is your dog on? How many meals do they eat a day? Do you weigh out their feed?
Is Your Dog Generally Food Motivated?
Do they eat their dinner quickly or pick at it? Do they like treats? Will they eat when anxious?
Does Your Dog Take Any Supplements?
Is Your Dog Confident And Happy In Water?
If your dog is anxious around water, we ensure a conscious approach to introducing hydrotherapy equipment that matches your dog's pace and learning.
Is Your Dog Friendly With Other Dogs In Passing?
Is Your Dog Generally Happy Being Handled And Meeting New People?
Are they anxious or excitable? Do they suffer for separation anxiety?
Have You Noticed Any Changes In Your Dogs Behaviour?
Has your dogs behaviour changed recently? Are they less active? sleeping more? Are they struggling with crate rest and full of energy? Have they become more grumpy towards humans or other dogs recently comparted to have they were previously?

Home Environment

If You Have Stairs At Home, Is Your Dog Allowed Up Them?
If you have any further comments on this please leave in the comment box at the end of this form.
What Types Of Floor Do You Have At Home?
Please select as many a relevant. If you have any further comments on this please leave in the comment box at the end of this form.
Does Your Dog Have Full Run Of The House? Have They Been Prescribed A Period Of Crate Rest?
Is Your Dog Allowed To Jump On And Off Of The Sofa & Beds At Home
If you have any further comments on this please leave in the comment box at the end of this form.
Have You Noticed Any Changes In How Your Dog Moves About The House?
Are they slipping on the floor? Are they moving more slowly and cautiously? Have they stopped, or started to struggle, with jumping up onto the sofa or going upstairs?
Does Your Dog Have Access To Outdoor Spaces At Home?
Please select as many a relevant. If you have any further comments on this please leave in the comment box at the end of this form.
Would You Be Interested In A Home Visit And Assessment From One Of Our Team To Help Identify Any Risk Factors For Injury/Re-Injury And Discuss A Home Management Action Plan?
If this is something you are possibly interested in it can be discussed further in your WhatsApp group or during your initial consultation.
Please write down any additional information...
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