Hainault Canine Hydrotherapy Centre

Owner Details
Contact Name:
Address
Telephone No.
Mobile No
Dogs Details
Name
Date of Birth
Breed
Colour
Sex
Vacination Expiry
Insurance Company
Policy Number
Veterinary Details
Contact Name:
Practice Name:
Address
Telephone No.
Fascimile No.
Please provide any further information about your dog that our therapist may need to be aware of:

I understand that hydrotherapy may not help all conditions and as with any physical activity, swimming can involve some risk.I have given all relevant medical and behavioural history above and will inform the centre of any changes to my dogs health.I authorise Hainault Hydrotherapy Centre to contact the veterinary surgeon named above to obtain confirmation that my dog is fit to swim and to discuss any aspects of my dogs health and treatment.

I declare that I am the legal owner of the above named dog, and that the information given on this form is correct, I have read and fully accept the terms and conditions set out by Hainault Hydrotherapy centre.



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