TheraPaws Therapy Plan
Owner Name
First Name
Last Name
Pet's Name
First Name
Last Name
Owners' Email
example@example.com
Owner's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner's Phone Number
Please enter a valid phone number.
Veterinarian
First Name
Last Name
Has veterinarian consented to indirect supervision?
Please Select
Yes
Not at this time
Veterinarian's email
example@example.com
Veterinarian's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veterinarian's Phone Number
Please enter a valid phone number.
Veterinarian's Diagnosis
Purpose of Therapy
Animal physical therapy (requires indirect supervision)
Therapeutic exercise
Massage
Senior Enrichment
Waist Watchers
Healthy Maintenance
Initial Consultation only
Other
Date
-
Month
-
Day
Year
Date
Goals
Underwater Treadmill
With incline
Without incline
With jets
Without jets
None
Land Treadmill
With incline
Without incline
Front limbs only
Back limbs only
Floor exercises
Shake Plate
Stability Equipment
Cavalettis
Sit to stand
Plank walking/sitting
Tunnel
Circles
Figure 8s
Wobble board
Trampoline
Ramps
Elevated sit to stand
Weight shifting
Weight bearing
Other
Massage
Other modalities (requires veterinary indirect supervision)
Environmental Enrichment
Senior Enrichment
Please Select
Yes
No
Maybe in the future
Weight Watchers
Please Select
Yes
No
Maybe in the future
Recommended
Home Exercise Plan (HEP)
Please Select
Yes
No
Recommended
Zoom Sessions for Home Massage
Please Select
Yes
No
Recommended
Recommendations for Home
Additional Comments
Submit
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