Aqua Canis - Online Veterinary Referrals

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Online Veterinary Referrals

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Page 1 of 5

OWNER’S DETAILS

Owner's Name*

Owner's Phone Number*

Owner's Email Address*

Confirm Owner's Email Address

Owner's Address*

Page 2 of 5

PATIENT'S DETAILS

Patient's Name*

Breed*

DoB/Age*

Sex*

Female

Male

Neutered/Entire*

Neutered

Entire

Most Recent Vaccinations and/or Titer Test (with Dates)

Page 3 of 5

OWNER’S DECLARATION

Patient's Medical History*

The patient's owner gives consent for the veterinary surgeon to share the patient’s medical history with Aqua Canis Hydrotherapy Centre and for it to be kept on file for the duration of treatments and programmes accessible to the patient.

Photography/Video

The patient's owner gives consent for Aqua Canis to share photographs and/or video images (including the patient and/or owners) on social media and/or other channels.

Please DO NOT share photographs and/or video images (including the patient and/or owners) on social media and/or other channels.

Datestamp - Owner's Declaration

Page 4 of 5

VETERINARY DETAILS

Practice Name*

Practice Tel*

Practice Email Address*

Practice Address*

Summary of the Patient's Injury/Condition*

Areas of Caution

Current Medication

Are You Aware of any Known Behavioural Issues?

Page 5 of 5

VETERINARY DECLARATION

Attach Patient's Clinical History

Optional Additional Attachment

Declaration*

In my opinion this patient is suited to undergo hydrotherapy and/or physiotherapy at Aqua Canis by qualified therapists.

Veterinary Surgeon's Name*

Datestamp - Veterinary Declaration

Before You Arrive

This is all you need to know before you attend your appointment.

Hydrotherapy Appointment Checklist

Downloads

Terms & Conditions

Vet Consent-Referral Form

Swim Consent Form

Core Values

We are committed to giving the best care to our canine clients and dedicated in delivering our therapies to the highest standards. We will continue to develop our practice and therapists to remain at the forefront of our industry. It is our passion to be inclusive of the mind, body and soul when we welcome our clients for therapies and wellbeing time.

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