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Rehab Initial Evaluation Questionnaire

Rehab Initial Evaluation Questionnaire

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Scheduling Availability

Rehabilitation Therapy Consent:

I authorize that I am the owner or legal guardian of the pet named above. I hereby provide my informed consent for the initiation of rehabilitation therapy for my pet with Trek Veterinary Surgery.

I acknowledge the following:

1. I have been informed about the nature, purpose, risks, and potential benefits of rehabilitation therapy for my pet.

2. I understand that the therapy may not guarantee a specific outcome and that the response to treatment may vary among individuals.

3. I understand that the therapy may involve physical manipulation and exercise, which could result in some level of discomfort or pain for my pet.

4. I consent to the administration of rehabilitation therapy for my pet under the supervision of licensed and trained veterinary professionals.

5. I understand that I am encouraged to remain present during the therapy sessions, and I will be informed of my responsibilities and any home care requirements.

6. I agree to follow all recommendations and instructions provided by the veterinary professionals for the well-being of my pet.

7. I understand that Trek Veterinary Surgery is not liable for any personal injury to myself during rehabilitation sessions performed both with the rehabilitation technician and at home personally between sessions.

8. I understand that the cost of rehabilitation therapy will be discussed separately, and I will be responsible for any associated fees.

By checking below, I agree to the following Cancellation Policy:

We understand that plans can change, and sometimes, you may need to cancel or reschedule your reservation. Please take a moment to review our cancellation policy below:

-Cancellations must be made at least 48 hours, or more, before your scheduled appointment date.

-Cancellations made less than 48 hours before your scheduled appointment date will result in a $150 cancellation fee, or forfeiture of one session from a pre-purchased treatment package.

If you have any questions or need assistance, please don't hesitate to reach out to our rehabilitation team at [email protected].