Therapy Client Registration:

Please read carefully, before you submit your registration form , Thank you

Notification: Please accept our sincere apologies, We are extremely busy with appointments, plus also a very high demand of new therapy referrals, because of this reason there is a waiting period for new client initial consultations of about 7-8 weeks (each case will be assessed). Policy: Please be advised, our therapy centre does not permit the owner to be present/stay with the dog for their IC appointment & for any sessions going forward, after many years of experience, We have found the dog responds better with the therapists if the owner is not present.

Your Full Contact Details

Please kindly completed this form in full, otherwise unfortunately we maybe not be able to proceed with your registration. Thank you

Full Name & Surname

Full Address with post code

Mobile Number*

Example +44 7712345689

Main Contact Email Address

Have you ever been to Dogtown before (Grooming/Daycare or Therapy).

Please advise, if you have ever had Therapy for your dog before, if so which Therapy Centre, did you attend for this treatment and was it for the same condition.

Your Dog's Details

Dog's Name and Surname

as known at your vets

Breed

Date of Birth

Sex*

Female Male

Approx Weight (kg)

Full details of condition/illness*

Please list the reason why you have approached us for Therapy for your dog. (OA- Arthritis/IVDD) in as much detail as possible.

Any other conditions or behavioural issues we should be made aware of.

Please kindly let us know of any other conditions or behavioural issues e.g skin condition/rashes, does not like water/needs to be muzzled etc. Thank you

Did your vet recommend Dogtown to you?

General Vet/Specialist Practice Details

Please enter the current vet's who is caring for your dog.

General Vet/Specialist Practice Name

Full Address with Post Code

Email Address

Contact Number

Other Vet/Specialist Details:

If your dog has had any surgery and the surgery/procedure was not undertaken at your general vet's, Please state the full details of where the surgery was done.

Vet - Specialist's Name

Please enter the full name of the practice.

Full Address Details with post code. Plus Contact Number.

Email Address:

Terms & Conditions

By completing & checking the box below, You are giving your consent for Dogtown to contact your Dog's Vets to obtain any Medical History required for Treatment & acknowledge Therapy Dogtown's T's & C's.

Agree To Our Terms & Conditions By checking this box, you are confirming you have read & accepted all policies stated within our Terms & Conditions.

Any Additional Information (optional)

Documents - Not Required to complete enquiry form - but if you can provide any relevant documents please attach here (e.g Discharge information).

Please enter Signature