Animal Bodywork Intake & Consent Form

Animal Bodywork Intake & Consent Form
Owner Information
Name *

First Name Last Name
Email *
example@example.com
Phone Number
Animal Information
Horse or Dog? *

Horse Dog
Animal's Name *
Age *
Breed
What type of session would you like? *
Reason for session *
Sports or Activities
Serious injuries if any (broken leg, surgeries, etc)
If yes, please specify on the field above.
Current medications
If yes, please specify on the field above.
Anything you would like to add
If yes, please specify on the field above.
Consent and Waiver

Release of liability for Amanda Nelson/Fluid Motion Agility
I, First Name* Last Name* , agree to fully and forever release and discharge, and defend, indemnify, and hold harmless, the practitioner and/or practitioner’s company, Amanda Nelson/Fluid Motion, and its owners, directors, officers, representatives, members, employees, or agents, and MagnaWave, and its owners, shareholders, directors, officers, representatives, employees, or agents, from any and all injuries (including death), losses, damages, claims (including negligence claims), demands, lawsuits, expenses, and any other liability of any kind, of or to me, my property or any other person, directly or indirectly arising out of or in connection with the PEMF/Massage services provided by practitioner and/or practitioner’s company.
I, Amanda Nelson have permission to use MagnaWave on Animal's Name* on behalf of (animal’s owner) First Name Last Name
.
Signature of the Client *

Clear
Date Signed *

Month Day Year
Date
Should be Empty:

Animal Bodywork Intake & Consent Form

Owner Information

Animal Information

Consent and Waiver