Massage Four Paws
Pomoting your pet's well-being through touch
Massage Four Paws Health Intake Form
Promoting the well-being of your pet through touch
Client Name: ____________________________________________________________________________________
Address: ________________________________________________________________________________________
City: _________________________________________ State: ___________________ Zip code: _____________
Phone #: ________________________________ Email: _______________________________________________
Veterinarian Information
Clinic Name: ____________________________________________________________________________________
Vet Name: ___________________________________ Phone #: ________________________________________
Address: ________________________________________________________________________________________
City: _________________________________________ State: _____ Zip code: _____________
Pet Information
Pet Name: ____________________________________ Sex: ____ Age: _____ Sp: ___ N: ___ In: _____
Health History/Concerns: _________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Special Needs/Diet/Medications:__________________________________________________________________
__________________________________________________________________________________________________
Training/Activities: _______________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________
Additional Comments/Plan: ______________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Client Signature: __________________________________________ Date of Service: ________________
Massage is not or intended to be a substitute for proper veterinary care