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Hydrotherapy Forms

Referral


Aqua Paw Hydrotherapy Centre

49 Coronation Street

Fredericton, NB E3A 4K5

506-470-4161

aquapaw.hydrotherapy@gmail.com

Client Information

Pet Information

Sex
Male
Female
Spayed or Neutered
Yes
No
Date of birth
Year
Month
Day
Referral Service(s) Requested
Are there any health conditions or contraindications that would make swimming a health risk? Are there any activity restrictions or special instructions, including, past injuries, surgeries, current medical conditions or special handling instructions?
Yes (Please explain below)
No
Does this dog have a bite history or aggressive tendencies when handled?
Yes
No

As the referring veterinarian, I understand that I remain the primary care provider. By signing this document, I am authorizing the certified practitioner(s) at Aqua Paw Hydrotherapy Centre to perform hydrotherapy with the identified patient.

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We truly value our relationships with our referring veterinarians. You are a part of our team and as such, we will be sure to keep you informed of all treatment plans, visits, etc. with your patients. We want to work with you to provide the best care possible for these patients. At "Aqua Paw Hydrotherapy Centre" we will provide rehabilitation and conditioning care only. Should we detect any other issues, your patient will be sent back to you for the necessary diagnostics and treatment. All rehab patients will require a referral from their veterinarian, even if we have seen them for unrelated issues. Although conditioning patients do not require a referral, we will request they contact you for a clearance to participate in a fitness program (i.e. to confirm no underlying cardiac disease or other ailments which may limit their activities).

Aqua Paw Hydrotherapy Centre

Aqua Paw

Hydrotherapy

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