1. Elizabeth Fey, CPMP Mailing Address: P. O
Elizabeth Fey, CPMP Mailing Address: P.O. Box 211 Bradford Woods, PA
We are pleased to welcome you to our practice. In order to maximize your pet massage experience, please take a few minutes to fill out this form and we will review it during your first session. We look forward to working with you and your pet. Pet Massage is not, nor is it intended to be a substitute for traditional veterinary care, if necessary; and upon your request we will be happy to work with your preferred vet to discuss your pet’s special needs.
Owner / Care Giver Information
Name:
Street Address:
City:
Cell / Home Number
Pet Information
Pet’s Name:
Species:
Breed:
Age / Birthdate
Color Markings
Gender:
Primary Reason for massage: ( mins*)
Overall Wellness
Athlete
Geriatric/Arthritis
Pre/Post Surgery
Socialization
Pre/Post Surgery
List any sensitive areas:
* Duration is dependent on your pet’s level of comfort
Pet’s Health and Wellness Information
Veterinary Hospital / Clinic:
Phone Number
Preferred Doctor:
Surgeries (Circle) Yes / No
if Yes please describe:
Family Pet
Rescue Pet
Spay or Neutered (Circle) Yes / No
Taking any Medication ( Circle) Yes / No
if Yes, please list:
Name of Kennel / Daycare:
Please Check all that apply to your pet
Service Pet
Multiple Pet HH
Outdoor (primary)
Hunt
Agility competition
Certified Therapy Pet