New Patient Form
Please complete this form to save time at your initial appointment, complete as much as you can,
By completing this section you are giving Treats K9 permission to contact your vet
Required field!Are they mobility aided with harness wheelchair or brace
Required field!Any other issues that could be important in treatment or handling eg: blind, deaf, amputee, aggressive, fearful
Required field!How did the condition start and how long it has been going on for
Required field!In the last week, on average, how long has your dog exercised each day?
Required field!In the last week, on average, how many walks has your dog had each day?
Required field!Check more than one box if necessary
Required field!1 being not disabled, 5 being being very disabled
Required field!What is the floor surface in the house where the dog is kept? Do they have to cross slippery surfaces? If so, are they steady on their feet?
Required field!Are allowed to get on the furniture, or if they can or can't, eg may be allowed, but cant get up, or isn’t allowed but does jump up, or can no longer get on the bed but can get on the couch, or can get on the bed but takes a few goes, or uses a ramp to get on the couch.
Required field!Are there any steps or stairs at home? How does the dog manage these? What surface are they? Are they blocked off? Make sure you indicate steps inside and outside, does the dog have to do steps to get to the toilet.
Required field!Are they lifted in and out or do they jump in?
Required field!Is the dog continent?
Any accidents with bladder or bowel?
Does he lift a rear limb to pee? Can he do it on either hind limb?
Can they hold the squat position to poop?
Do they walk along when pooping, is this new or has the dog always done this?
Required field!Please provide details
Required field!Please provide details
Required field!Please provide details
Required field!Are they having any other therapies or do they have a current rehab program they are following?
Required field!