Laser Therapy Questionnaire

Client Name

Date

How many sessions of laser therapy treatment (s) has your pet received?

1 2 3 4 5 6 or more

Have you noticed any improvement in your pet's condition since starting laser therapy?

Pet seems more comfortable Pet is no longer limping Pet's mobility has improved overall Pet seems happier/more energetic Pet's wound has accelerated healing Other

Yes. If yes please check all that apply:

Pet seems more comfortable

No Yes. If yes please check all that apply:

Please expand on the changes noted, if possible

If improvement has been noted, how long did the effects of the treatment last?

24 hours or less 24-48 hours Less than 1 week 1-2 weeks 2 weeks-1 month 1 month or longer During and immediately after treatment only

Is your pet receiving any other other medication, therapy or treatment for this condition?

Yes No

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?

Yes

Yes No

How likely are you to recommend laser therapy to others?

Extremely Likely Likely Maybe, not sure Probably not Definitely not Will advise against it