• Small Animal New Client Intake Form

    Thank you for choosing Anna Gezon Equine Massage Therapy LLC! Please complete one form for each animal before your first appointment. The information you provide helps ensure every session is safe, personalized, and tailored to your pet's individual needs.

  • Owner Information

  • Format: (000) 000-0000.
  • Preferred Contact Method*

  • Pet Information

  • Date of Birth
     - -
  • Sex*
  • Spayed/Neutered*

  • Medical History

  • Veterinary treatment or procedure within the past 30 days*
  • Implanted medical devices, metal implants, or orthopedic hardware*
  • Currently pregnant or nursing*
  • Open wounds, skin infections, contagious illness, fever, or other active medical concerns*

  • Behavior & Handling

  • Has your pet ever shown fear, anxiety, aggression, or other behavioral concerns during veterinary visits, grooming, rehabilitation, or handling?*
  • Are there any painful areas or areas that should not be touched?*
  • Are there any handling preferences or special instructions?*

  • Current Concerns & Goals

  • Primary reason for today's visit*
  • Recent changes noticed
  • Recent changes*

  • Consent

  • I certify that I am the legal owner or authorized agent of the animal listed on this form and have the authority to consent to treatment.

    I understand that the services provided by Anna Gezon Equine Massage Therapy LLC, including but not limited to massage therapy, Pulsed Electromagnetic Field (PEMF) therapy, red light therapy, and other complementary therapies, are intended to support comfort, mobility, recovery, and overall wellness. These services are not veterinary medicine and are not intended to diagnose, prescribe, or treat disease or replace veterinary care.

    I understand that no specific results or outcomes can be guaranteed.

    I agree to inform Anna Gezon of any changes in my pet's medical condition, medications, injuries, pregnancy status, surgeries, or veterinary restrictions before each appointment.

    I understand that it is my responsibility to disclose any known medical conditions, contagious illnesses, implanted medical devices, metal implants, recent veterinary procedures, or other health concerns that may affect treatment.

    I understand that complementary therapies may not be appropriate for every animal or medical condition. Anna Gezon reserves the right to modify, postpone, or decline treatment if it is determined that services may not be in the animal's best interest or if veterinary clearance is recommended.

    I understand that my pet may experience temporary soreness, fatigue, or mild changes in activity following treatment, which are generally considered normal responses.

    I agree that my pet will remain under my supervision or that of an authorized handler during treatment unless otherwise instructed.

    I release and hold harmless Anna Gezon Equine Massage Therapy LLC, its owner, employees, and representatives from liability for injuries, damages, or losses arising from the animal's participation in treatment except in cases of gross negligence or willful misconduct.

    By signing below, I acknowledge that I have read, understand, and voluntarily agree to the terms of this consent and liability waiver.

  • Date*
     - -

  • Optional Media Consent

  • May Anna Gezon Equine Massage Therapy LLC photograph or video your pet for educational or promotional purposes?*
  • Privacy statement
  • Should be Empty: