Laser Therapy Questionnaire

Laser Therapy Questionnaire
Client Name
Date

MonthDayYear
Date
123456 or more
Pet seems more comfortablePet is no longer limpingPet's mobility has improved overallPet seems happier/more energeticPet's wound has accelerated healingOther
Yes. If yes please check all that apply:
NoYes. If yes please check all that apply:
Please expand on the changes noted, if possible
24 hours or less24-48 hoursLess than 1 week1-2 weeks2 weeks-1 month1 month or longerDuring and immediately after treatment only
YesNo
If yes, please list what you can. (Include all physical therapy, acupuncture, holistic treatments, pain medications, and supplements Are you likely to pursue further laser treatments in the future?
YesNo
Extremely LikelyLikelyMaybe, not sureProbably notDefinitely notWill advise against it
Should be Empty: