NEW CLIENT FORM
Menu
Guelph Animal Hospital's homepage
CALL OUR TEAM
519-836-2782
AFTER-HOURS (CAMPUS ESTATES)
519-837-1212
REQUEST AN APPOINTMENT
Open contact us menu
IvcPractices.HeaderNav.Search.Toggle.Button.Aria
Guelph Animal Hospital's homepage
About Us
Our Team
Hospital Tour
Careers
Services
Traditional Medicine & Services
Integrative Medicine & Therapies
Pain Management Program
Veterinary Specialist Referrals
Pet Health
Community Care
Credit Application
Pet Food Recalls
Product Recalls
Web Resources
Contact
Shop Online
IvcPractices.HeaderNav.Search.Toggle.Button.Aria
IvcPractices.HeaderNav.Search.Label
Submit
Pain Management Clinic Screening Form
OWNER INFORMATION
Full Name *
Email *
PET INFORMATION
Pet's Name *
Primary Concern:
How long has this problem been present?
What goals/outcomes would you like to achieve with this program?
Other health concerns (if applicable):
Current medications:
Current supplements:
Current diet:
Date of last wellness bloodwork and 4DX (heartworm and tick disease testing):
Does your pet do any sports (e.g. agility, dock diving, flyball)? If yes, which ones?
Radiographs of affected area and date if applicable:
Referral/specialist visit history:
Therapies interested in (check all that apply):
Acupuncture
Laser
Manual Therapy (Chiropractic Treatments)
Rehab
PRP
Pain Medication
Therapeutic Diets
Supplements
CBD
Other Herbals
Please note, all patients should have current bloodwork (within the last 6 months) as well as radiographs if recommended by your primary veterinarian. Depending on our assessment, our pain management team may recommend repeating one or both, which can be done with your regular vet or here with us. Rabies is required by public health, all pets must have a current rabies vaccine prior to enrolling in our pain management clinic. Medical exemptions are permitted at the discretion of the veterinarian.
Security Question *
I HAVE READ AND UNDERSTOOD THE
PRIVACY POLICY
*
Back
Menu
About Us
Our Team
Hospital Tour
Careers
Services
Traditional Medicine & Services
Integrative Medicine & Therapies
Pain Management Program
Veterinary Specialist Referrals
Pet Health
Community Care
Credit Application
Pet Food Recalls
Product Recalls
Web Resources
Contact
Shop Online
REQUEST AN APPOINTMENT
NEW CLIENT FORM