Hydrotherapy Initial Assessment Form - Woozelbears - Canine Hydrotherapy and grooming- Support, Treat, Rehabilitate

Step 1 of 8

Initial Assessment:
Preferred Branch*
Referring vets*
Client name*
First Last
Email
Client address*
Street Address City County ZIP / Postal Code
Contact number*

Dog name*
Age
Breed*
Sex*
- Male
- Female
Neutered*
- Yes
- No
Vaccinated*
- Yes
- No
Insured*
- Yes
- No
Company

Veterinary diagnosis*
Other Medical Conditions*
Current medications or supplements*

Current Exercise
How many walks a day is your dogs getting?*
How long are the walks in duration?*
Is your dog doing off lead exercise?*
- Yes
- No
If so, how long for?
Has your dog received any other therapies such as physiotherapy?*

Nutrition
Is your dog the correct weight?*
Do they have any allergies?*
Home environment
Is your dog going up and down stairs?*
- Yes
- No
How does your dog get in or out of the car?*
Does your dog sit on the sofa?*
Do you have slippery floors at home?*

Summary
How do you feel your dog has been affected by their condition?*
What are your expectations of the hydrotherapy treatment?*
Is there anything that your dog used to be able to do that they now can’t?*
On a scale of 1 to 10 (10 being the worst) do you feel your dog is in pain?*
Anything else you would like us to know?*

Disclaimer
Owners and animals use the facility at their own risk. We cannot therefore accept responsibility for any injury suffered by owners or animals using facilities. We also cannot accept any responsibility for any loss or damage to personal belongings whilst on the premises.
Owners and animals use the facility at their own risk. We cannot therefore accept responsibility for any injury suffered by owners or animals using facilities. We also cannot accept any responsibility for any loss or damage to personal belongings whilst on the premises.*
I have read, agreed and understood this disclaimer
Owners and animals use the facility at their own risk. We cannot therefore accept responsibility for any injury suffered by owners or animals using facilities. We also cannot accept any responsibility for any loss or damage to personal belongings whilst on the premises.
Terms & Conditions Consent*
I have read, agreed and understood the terms and conditions
Terms and Conditions

1. Whilst every care is taken of the dogs undergoing treatment and in the maintenance of the water and equipment, all dogs receive treatment entirely at their owner’s risk.
2. All treatment courses, including those to be part of an insurance claim, must be paid for in advance. Individual sessions must be paid for on the day of treatment.
3. Session fees will be charged in full if an appointment is broken or cancelled without 24 hours notice.
4. Dogs cannot be treated without the prior authorisation of their Veterinary Surgeon unless attending for recreation or fitness only.
5. Dogs with infectious or contagious conditions, such as ear, eye and skin infections, gastric upset, will not be treated. Owners are advised to cancel appointments with at least 24 hours notice, and rearrange 48 hours after the condition has cleared. Normal cancellation conditions will apply. In the case of Kennel Cough please rebook 14 days after the last cough.
6. Bitches in season will not be able to attend sessions until their season has finished.
7. We will require each dog to be fully vaccinated prior to the commencement of Hydrotherapy. Dogs cannot be swum without up to date vaccinations, unless a valid reason can be provided.
8. Owners are required to notify Woozelbears if, during a course of hydrotherapy, the dog’s injury or condition worsens, or if your vet advises that sessions should be stopped or suspended.
9. Owners are requested not to feed their dog for at least 3 hours before attending an appointment and to ensure that the dog has been to the toilet before arriving. We also advise not to feed for at least 2 hours after swimming. A surcharge of £60 is chargeable dependent on the time taken to restore the equipment back to its original state.
10. When not having treatment, all dogs will be kept under control and must be on a lead at all times.
11. It is the owner’s responsibility to poop scoop after their dogs whilst on our premises.
12. Woozelbears cannot be held responsible for any loss or injury to any person or animal, howsoever caused, whilst on our premises.
13. Woozelbears cannot be held responsible for any loss or damage to vehicles or personal property, howsoever caused, whilst on our premises.
14. We reserve the right to use any video footage or photographic stills taken during sessions.
15. When visiting we require you to wear clean, non-slip soft soled footwear to protect our hydrotherapy floors. The floor may become wet during hydrotherapy treatment sessions and may become slippery.
16. The duration and the intensity of the session will be determined by the Hydrotherapist and is dependent on the dog’s health and fitness. Furthermore, Woozelbears reserves the right to refuse treatment to any dog.

17. If you have not attended for more than 6 months a new referral form from your vet is required.
Refund Policy Consent*
I have read, agreed and understood the refund policy
Return & Refund Policy for Woozelbears

Thanks for shopping at Woozelbears. If you are not entirely satisfied with your purchase, we're here to help.

Returns

You have 30 calendar days to return an item from the date you received it. To be eligible for a return, your item
must be unused and in the same condition that you received it. Your item must be in the original packaging. Your
item needs to have the receipt or proof of purchase. Unfortunately, we are unable to accept returns of frozen

goods.
Refunds

Boutique - Once we receive your item, we will inspect it and notify you that we have received your returned item.
We will immediately notify you on the status of your refund after inspecting the item. If your return is approved,
we will initiate a refund to your credit card (or original method of payment). You will receive the credit within a

certain amount of days, depending on your card issuer's policies.

Services – Due to their nature we are unable to offer refunds on hydrotherapy, K-laser, grooming or other non-
tangible services. In cases relating to block purchases, refunds for unused sessions must be sought within 30days of
purchase unless the patient is deemed no longer suitable for their treatment where upon a refund will be issued
upon presentation of a Veterinary letter of confirmation up to 30days from their last treatment session.

Contact Us

If you have any questions on how to return your item to us, contact us.
Date*
MM slash DD slash YYYY
Signature*
Thank you for completing our initial assessment form, this will give us important information to help us create your dog’s bespoke treatment plan when we meet.
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Email
This field is for validation purposes and should be left unchanged.

0333 311 0182

Step 1 of 8

Initial Assessment:

Current Exercise

Nutrition

Home environment

Behaviour

Summary

Disclaimer