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Post Surgical Owner Assessment
Pet's Name
*
Nickname(s)
*
Please list current medications and any other medical conditions/Injuries (include dates if condition or injury was in the past).
If condition is due to an accident, when did your pet’s injury occur?
MM slash DD slash YYYY
How did it occur?
Has your pet seemed painful in the last week?
*
Yes
No
If yes, when?
*
MM slash DD slash YYYY
What commands does your pet follow (i.e. Sit? Heel?)? What is the word you use for “treats”?
May your pet receive Science Diet treats during the therapy session? (If not, please bring appropriate treats for your pet.)
*
Yes
No
What is your pet’s favorite motivator? (Ball? Treats? Petting?)
How many caregivers for your pet are in the home?
What specific goals do you have for your pet’s recovery? (Examples: (1) Climb 4 stairs into home without assistance, (2) Resume jogging 3 miles with me, (3) Regain strength to play with children, (4) Return to hunting.)
Additional Comments
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Phone
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