Booking an Appointment

Any physiotherapist must ask for a consent form to adhere to professional practice and to protect your animal under The Veterinary Surgeons Act 1966 (only with Veterinary consent may an animal have Physiotherapy Treatment). This ensures I am aware of any contraindications and reassures you that you are getting a professional service.

Please complete the below form, or download a copy to send to your registered veterinary practice and bring to your first appointment.

Download Vet Referral Form

Fill Out the Form Below to Book

Owners Name

First Name

Last Name

Contact Number

(###)

###

####

Email Address

Home Address

Your home address (If using this for a horse booking please leave details of the stables at the end)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Animals Name

Approx Age

Which Species is your Animal?

Canine

Equine

Feline

Other

Animals Information

This can outline any problems or concerns. Highlight any behavioural issues or just tell me their favourite treats!

My Registered Vet is:

Please give the name of the vets where this animals is registered

Will physiotherapy be paid by insurance?

Please give details of insurance company if "Yes"

Yes

Insurance Company

Only complete if answered "Yes" to the above

Reason For Contact

Why are you looking to book physiotherapy today?

Veterinary Referral

Owners Decision

Further Details

Anything to add?

Terms and Conditions

If you would prefer to contact your vet directly please download the paper form and bring to your first appointment instead.

By checking this box I agree to allow my Vet to be contacted on my behalf in accordance to the 1966 veterinary surgeons act. I agree to Terms and Conditions outlined on the website.