New client intake

New Client Intake Form

Please allow around 15 minutes to complete this form before your first appointment. The detail you share helps me understand your dog’s history and needs, prepare for their visit and make sure you both get the most from your first session. It also gives me the information and your permission to contact your vet and arrange any veterinary consent needed before treatment.

Have a general question or would like to enquire about booking an appointment? Please use the contact form.

Begin the New Client Intake Form Fill out contact form

Before you begin

Please set aside around 15 minutes. It helps to have the following nearby:

Your veterinary practice details
Insurance details
Medication names, doses and frequency
Any discharge notes, reports or imaging summaries

One straightforward formClear sections, with extra questions shown only when they are relevant.

Helpful uploadsYou can attach veterinary handover notes and supporting documents.

Not for emergenciesIf your dog needs urgent care, please contact your veterinary practice directly.

Your dog’s information

A little detail now helps me prepare properly

Please complete this before your first appointment so I have time to review your dog’s history and contact your vet. Fill in as much as you can; approximate details are fine if you are unsure. Some follow-up questions only appear when relevant. Required fields are marked with an asterisk.

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Your details

Your contact details.

Your name *

First

Last

Your email *

Your phone *

Your address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Your dog’s details

Your dog’s name *

Breed *

Colour *

Sex and neutering status *

Weight (kg)

Date of birth *

If your dog’s date of birth is unknown, please give your best estimate or use the date recorded by your veterinary practice.

Your dog’s health and goals

Only include what you know. Veterinary reports or handover notes can be uploaded below.

What is the main reason you are bringing your dog to me? *

Rehabilitation following injury or surgery
Age-related changes or slowing down, including osteoarthritis
Pain, stiffness, lameness or a change in movement
Sporting or working dog fitness and conditioning
General physical-health assessment or yearly MOT
I have been specifically recommended Class IV laser therapy
I’m not sure and would like guidance

Select all that apply.

Please tell me more about what prompted you to contact me *

Tell me what you have noticed, when it began if relevant, and what you would most like help with.

What would you most like to achieve / what is your goal? *

This might be greater comfort, easier daily movement, returning to an activity, improved fitness or simply a thorough check.

Medical history

Include current and previous conditions, injuries, operations or investigations, with approximate dates if known. Leave blank if none.

Current medication and supplements

Please include the name, dose and frequency of any medication or supplements your dog takes. Leave blank if none.

Health considerations *

None known
Seizures or epilepsy
Heart or respiratory condition
Open wound, stitches or skin infection
Tumour, undiagnosed lump or cancer treatment
Recent surgery
Current infection or contagious illness
Pregnancy
Diabetes
Pacemaker
Other

Veterinary instructions or current activity restrictions

For example: lead walks only, exercise limits or postoperative guidance. Leave blank if none.

Has your dog previously received physiotherapy or rehabilitation? *

Previous physiotherapy or rehabilitation details

Please include the clinic, type of treatment and approximate dates.

Early life

Have you had your dog since a puppy? *

Yes
No
Unknown

How old was your dog when they joined you?

How did they settle in?

Daily life, activity and behaviour

This helps me understand what matters to you and plan a calm, practical first appointment.

Usual exercise, work or sport *

Describe your dog’s normal walks, play, work, sport or training before the current concern, where relevant.

Have you had to change your dog’s exercise or activity due to recent events?

Please describe any changes and the reasons for them. Leave blank if not relevant.

Changes or difficulties you have noticed *

None
Rising or lying down
Sitting or standing
Walking or running
Stairs
Jumping into the car or onto furniture
Slipping on floors
Toileting
Lameness or stiffness
Muscle loss or weakness
Changes in behaviour or confidence
Other

Diet and behaviour

Current diet and feeding routine

What food does your dog eat (type and brand), how much and how often? Include treats, appetite changes and any recent weight changes.

Is your dog food motivated?

Yes
No
Sometimes

Food allergies or products to avoid (if relevant)

Behaviour and handling *

No known concerns
Worried by other dogs
Worried by new people
Worried in unfamiliar places
Worried at the vet
Uncomfortable being touched or handled
History of growling, snapping or biting
Other

Further details of behavioural concerns or recent changes in behaviour

Please give any relevant details, or leave blank if none.

Anything that will help your dog feel safe and comfortable

Home environment

Property type

House
Flat or apartment
Bungalow
Van or caravan
Other

Stair access

Yes freely
Yes supervised
No
No stairs

Sofa or bed access

Yes freely
Yes supervised
No never
No but previously

Flooring

Carpet
Tile or stone
Wood
Laminate or vinyl
Other

Prescribed crate or room rest?

Crate/room rest details

Changes moving around home?

Moving around home details

Outdoor access

None
Small or moderate grass garden
Large grass garden
Patio
Stones or gravel
Steps
Other

Will your dog need assistance getting from the car into the clinic? *

Yes
No
Unsure

Any further comments?

Your veterinary practice

I will use these details to obtain veterinary consent and relevant clinical information.

Registered veterinary practice *

Other practice name and branch *

Practice phone *

Practice email

Insurance, consent and final details

A few final details before you send the form.

Are you planning to claim for treatment through pet insurance? *

Yes
No
Not sure yet

If you select Yes or Not sure yet, please provide your insurance details below if available.

Insurance provider

records assessment Second

Policy number

Consent and important information

Owner declaration *

I confirm that the information I have provided is accurate to the best of my knowledge and that I am authorised to consent on behalf of this dog.

Treatment consent *

I consent to appropriate physiotherapy assessment and treatment. I understand that recommendations will be based on clinical findings and may change as my dog progresses.

Privacy and clinical records *

I understand that my personal data and my dog’s clinical information will be stored securely and used to arrange and provide care, communicate with me, liaise with relevant veterinary professionals and maintain clinical records.

Please read the Privacy Policy before ticking this box.

Terms and Conditions *

I have read and agree to The Dog Physio’s Terms and Conditions, including the cancellation and payment policy.

Please read the Terms and Conditions before ticking this box.

Clinical photographs or video for assessment and progress records *

Yes, I consent
No

May photographs or video be used for The Dog Physio’s website, social media or educational material?

Yes
No
Please ask me each time

Typed full name *

Please type your full name. You can also draw your signature in the box below.

Signature

Clear Signature

Draw your signature using your finger, mouse or stylus. If drawing is difficult, your typed full name above can be used instead.

Please note: submitting this form does not confirm an appointment. I will review your dog’s information and contact you with the most appropriate next step.

A simple next step

Choose the right route

Owners can start with a simple enquiry. Veterinary professionals can use the dedicated referral form.

Tell me about your dog Refer a patient