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Canine Massage Therapy in Orono, Ontario and Durham Region
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Please fill out this health history intake form with as much detail as possible prior to your first session.
Name
*
Email
*
Phone
*
Address
*
Dog info, including Name, Age, Sex, Breed, and Weight
*
Vet info, including Name and Phone Number
*
Dog is up to date on vaccinations
List any medications/supplements
*
List any allergies
Check any of the following conditions that your pet currently has
Arthritis/Joint/Orthopedic problems
Neck/back injury
Cancer
Kidney or Liver Problems
Skin Condition
Heart Problems
Diabetes
Low Energy
Poor Appetite
Laboured Breathing
Frequent Soft Stools
Frequent Vomiting
Any other illness, injury, or surgeries?
If your dog appears to be in pain, please explain where and how it presents (ie. limping/lameness, difficulty getting up stairs, sloppy sit, wimpering, etc.)
*
What type of food and snacks does your dog get?
Please check all the following that apply to your dog
Regularly jumps off couches/beds
Regularly chases after balls/sticks/toys
Does agility training
Wears a harness on walks
Wears a collar on walks
Tugs on leash during walks
Gets daily walks
Has your dog shown signs of aggression towards people before? If yes, please explain
Is there anything else that I should know about your pet?
What are you hoping to achieve with Paws And Prana?
*
How did you hear about Paws And Prana?
*
Submit
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