Client Consent Form

Sally Anderson
Unit 19 Manor Road Business Park, Manor Road, Scarborough, YO12 6BE
scarboroughscentdogs@outlook.com 07789968346
Client Consent Form
Client Details
Name*
Address*
Phone*
Email*
example@example.com
Insurance company (if applicable)
Dogs Details
Dogs Name*
Dogs Breed*
Sex*
Neutered*

YesNo
Vet Practice*
Phone*
Owners Declaration
I am the legal owner of the dog and give consent for it to be massaged and receive rehabilitation therapies to which we fully accept the attached terms and conditions. I confirm that I have contacted the dogs Vet to discuss it receiving treatment and that there is no contraindication to massage or rehabilitation therapies. If during the massage the therapist deems that the veterinarian should be consulted, then the owner will be informed and veterinarian contacted.
I consent to my dogs' photograph being shared as part of advertising for Scarborough Scent Dogs
Signature

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Date

MonthDayYear
Date
Should be Empty:

Dogs Details