Client Application Form If you prefer, you can download, print, and return the Client Application Form. Also, please Download, Print, and Sign the Client Application Release Form "*" indicates required fields Dog's Name Age Breed Your Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Veterinarian InformationEnter Regular Vet, Orthopedic Vet, Chiropractor, Acupuncturist, other relevant Vets.Vet NamePhone Add RemoveHas your dog had a recent injury? Yes No If yes, please describe belowHas your dog had a recent surgery? Yes No If yes, please describe your understanding of the surgery.When was the surgery? By Whom? What side it was performed on? Etc.Please describe and list the dates of any other/older past injuries and surgeries.How are you hoping that your dog will benefit from spa therapy?Does your dog have any problems with bowel/bladder control? Yes No If yes, please explain.Please describe your beliefs about vaccinations and your vaccination schedule.Please list methods, if any, that you use for flea control on your pet and at home.Please do not use topical flea/tick products on your pup within 5 days of your spa session. Studies have shown that these products can leach into the pool and onto your therapist! Thank you!Please describe your dog's home environmentWhere/How does he spend the day? The night?Do you have children? Yes No Do you have other dogs? Yes No If yes, what are their names, breeds and ages? Please describe your dog's relationship with water?Does your dog enjoy swimming after toys? Yes No If yes, what type?Does your dog enjoy being held and massaged? Yes No If yes, please write any comments below.Please describe any emotional components of your canine friend that you would like me to be aware of so that I can better honor his/her boundaries and help him/her to be as comfortable and confident as possible during our sessions together.What do you feed your dog?Feeding Schedule? What kind of treats does your friend enjoy? If treats are given, how many and how often do you give them? Please list supplements of any type that you give to your dog.Please list the supplement, how often given, reason given and by whom they were prescribed.Please list any medications that you give to your dog.Please list the medication, how often given, reason given and by whom they were prescribed.Agreement* I agree.NameThis field is for validation purposes and should be left unchanged.