Canine Consent Form

Please fill out the following form.

Full Name

Address

Phone

Email

Animal Name

Sex

Age

Breed

Is your dog involved in any sporting activities

No - House hold pet

Yes

If yes please specify

Daily activity level - Walked per day & for how long

Has your dog ever shown any signs of aggression & is there anywhere they do not like to be touched?

I am happy to allow photos of my animal to be taken and used for social media and advertising purposes.

Yes

No

I, the owner of the dog named above give my consent for this animal to receive physiotherapy treatment from McMasters Veterinary Physiotherapy.

Signature

Signature field is empty.

Date

Canine Owner Consent Form