Veterinary Consent Form

Patient Information

Dog's Name:

Breed:

Age:

Weight:

Sex:

Color/Markings:

Owner Information

Owner's Name:

Phone Number:

Email Address:

Address:

Medical History & Current Condition

Primary Diagnosis/Reason for Hydrotherapy:

Recent Surgery/Procedures (if any):

Current Medications:

Known Allergies:

Veterinary Assessment

Please check all that apply:

Patient is physically stable for hydrotherapy No contraindications to hydrotherapy present Patient is up to date on vaccinations No open wounds or skin infections Patient is not currently experiencing severe pain No respiratory distress or breathing difficulties Patient is not pregnant No heart conditions that would contraindicate exercise

Treatment Recommendations

Recommended frequency of sessions:

Session duration recommendation:

Special considerations or precautions:

Veterinary Consent & Authorization

I, the undersigned veterinarian, certify that:

I have examined the above-named patient and reviewed their medical history I believe hydrotherapy is medically appropriate for this patient I have discussed the treatment plan with the owner I authorize On Point Aqua to provide hydrotherapy services as outlined above I will be available for consultation during the treatment period I understand that On Point Aqua will provide progress reports as requested

Veterinarian Signature

Dr. _________________________

License #: ___________________

Date: _______________________

Owner Signature

Owner: _____________________