Forms - La Paw Spa - Cindy Horsfall

Client Information Form

If you are interested in therapy for your dog – please fill out this form and hit the submit button.

You don’t need to print, I’ll get a copy this way and will print it for the file on my end.

Thank you and I look forward to meeting you and your dog!

Click on the red “+” to expand the form, fill it out and submit.

Client Application Form

Dog's Name:

Age:

Breed:

Your Name:

Address:

City

State:

Phone

VETERINARIAN INFORMATION

Regular Vet:

Phone:

Orthopedic Vet:

Phone:

Chiropractor:

Phone:

Acupuncturist:

Phone:

Other:

Phone

Other:

Phone

Has your dog had a recent injury?

If yes, please describe below

Has your dog had a recent surgery?

When?

By Whom?

Please describe your understanding of the surgery, 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?

Paragraph

(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 environment (Where/How does he spend the day? The night?)

Do you have children?

What are their ages?

Do you have other dogs?

If yes, what are their names, breeds and ages?

Please describe your dog's relationship with water

Does your dog enjoy swimming after toys?

If yes, what type?

Does your dog enjoy being held and massaged?

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, the undersigned, am engaging Cindy Horsfall and La Paw Spa, LLC, for the purposes of providing me with instruction in Cindy’s experience of Canine Water Therapy. I understand that this class does not give me legal license to practice or satisfy any legal requirements of any kind. I further agree to release and hold harmless from any and all liabilities and will take these classes at my own risk. I understand that this is a release of all current and prospective claims and that I am of legal age to sign. I understand that upon receipt, Cindy will confirm availability and let me know. Should I need to cancel, I understand that all monies paid for class are non-refundable unless Cindy can fill my spot, unless otherwise noted..

Signature *

Student Application Form

If you are interested in learning more about the world of canine hydrotherapy and serving dogs and their people, please fill out this form and hit the submit button and I’ll print for your file on my end.

I look forward to meeting you and helping you further your path in this wonderful field of supportive canine healthcare.

Click on the red “+” to expand the form, fill it out and submit.

Student Application Form

Student Application

Date:

Your Name:

Address:

City

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

Your Current Occupation:

Your Interests

Your interest in this work:

Your interest/love of being in the water:

Do you like to give massage?

Yes

Do you like receiving massage?

Yes

Your other outside interests and hobbies:

Your Inspiration

Your inspiration for becoming interested in this path of service:

Your Experience

Your experience with dogs:

Your experience with people:

Do you like people?

The relevant classes you have taken:

About You

Your physical health and condition - how much weight can you lift:

Any other comments or relevant information that you care to provide:

Your Dreams and Aspirations:

If you absolutely could not fail and you could have anything you wanted in life, how would you use your interest in canine water therapy? What would this business look like? Services offered? Dare to dream and write it here:

Select Your Class options for the Heart of Canine Water Therapy - Combination Level 1 and 2

Check your selection below:

The Heart of Canine Water Therapy - Customized Level 1 and 2. (Private - specify date below.)

The Heart of Canine Water Therapy - Customized Level 1 and 2. (Semi-Private - specify date below.)

Date

Combination Level 1 and 2 will be held in Sequim, Washington.

Meals & Lodging *

I will be responsible for all of my lodging, meals, and transportation during class.

Yes! Sign me up! *

Signature *