Intake FOrm

Name *
Name
Address *
Address
Phone *
Phone
Sex *
Neutered/Spayed? *
Please include any information about general health, current medications, past surgeries and accidents:
Consent *
By checking this box, I understand that Erin Kowalski is not a licensed veterinarian and does not diagnose, perform surgery, or prescribe medications. I also understand that muscle therapy and energy work are not a replacement for proper veterinary care and that any injuries or diseases must be medically diagnosed and treated by a veterinarian and give permission for Erin Kowalski to work on my pet. I further understand that a complete history is necessary for accurate treatment of any kind and that participation by the owner/handler is essential to achieving beneficial results. Further, I understand that Erin Kowalski is not responsible for any damages to others or to any property caused by my dog. Please note that appointments not cancelled at least 24 hours before the scheduled time will be billed at 1/2 the normal rate.