New client intake

New Client Intake Form

Please use this form if you are ready to proceed with an appointment or have been asked to complete it. It collects the full information I need to prepare properly and begin any required veterinary-referral or consent process.

Have a general question or still unsure whether physiotherapy is suitable? Use the Contact form first.

Begin the New Client Intake Form

Before you begin

It usually takes around 10–15 minutes. It helps to have the following nearby:

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

Four simple stepsYour details, health history, daily life and consent.

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

Complete each step as fully as you can. If something does not apply, write “None” or choose the closest option. Required fields are marked with an asterisk.

Please enable JavaScript in your browser to complete this form.

- Step 1 of 4

Step 1 — You and your dog

Your name *

First

Last

Your email *

Your phone *

Your address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Your dog’s name *

Breed *

Age or date of birth *

Sex and neutering status *

Weight (kg)

Colour

What would you like help with? *

Physiotherapy and rehabilitation
Postoperative rehabilitation
Class IV laser therapy
Stance and weight-distribution analysis
Mobility or physical-health check
Proactive care or annual physiotherapy MOT
I am not sure and would like guidance

Owner authority *

I confirm that I am this dog’s owner or I am authorised to make decisions about their care.

Step 2 — Health and veterinary care

What have you noticed, and what would you like help with? *

Please include when it began, changes you have noticed, any diagnosis or surgery, and what you hope your dog can achieve.

Relevant medical history, investigations and previous treatment *

Include relevant surgery, imaging, test results, previous treatment and current management.

Current medication *

Please include medication, dose and frequency, or write None.

Diagnosis, operation and relevant dates

Supplements, allergies and food intolerances

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
Other

Current veterinary instructions or activity restrictions

Has your dog previously received physiotherapy, hydrotherapy or rehabilitation? *

Previous rehabilitation details

Veterinary details

Veterinary practice *

Usual veterinary surgeon

First

Last

Practice phone *

Practice email

Specialist or referral centre

Veterinary reports and supporting documents

Drag & Drop Files, Choose Files to Upload

Upload discharge notes, reports, imaging summaries or previous treatment notes if available.

Veterinary permission *

I give The Dog Physio permission to contact my dog’s veterinary practice or referral centre, obtain veterinary consent and relevant clinical information, and share appropriate treatment updates.

Step 3 — Daily life, movement and handling

Usual exercise before this concern *

Current exercise and activity *

What would you most like your dog to be able to do? *

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

Home environment *

Carpet
Wood or laminate
Tile or stone
Stairs
Steps to the garden
Other

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

Anything that will help your dog feel safe and comfortable

Favourite treats or rewards

Breed name for

Food allergies or products to avoid, including peanut products

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

Yes
No
Unsure

Step 4 — Insurance, consent and submission

Is your dog insured? *

Do you intend to claim for treatment? *

Yes
No
Unsure

Insurance provider

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

Date *

Drawn signature (optional)

Clear Signature

You may draw your signature here, or use the required typed-name field below.

Typed full name *

Type your full name as your accessible signature. This is required even if you also use the drawing box above.

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