Name: Village Park Animal Hospital
Address: 51230 Eisenhower Dr., La Quinta, CA, 92253, United States
Telephone: 760-564-3833
Price range: $

AQUAPAWS INFORMED CONSENT

Please fill out this form as completely as possible.
If you have any questions, don’t hesitate to contact us at 760-564-3833.

Name *

Email *

Pet's Name *

Primary Veterinarian's Name *

It has been recommended that your pet, referred under the primary care of your veterinarian, receive physical rehabilitation services. These services will be performed by Kathryn Carlson, DVM at Aquapaws, a division of Village Park Animal Hospital. This form is to make you aware of the procedures that may be included in your pet’s rehabilitation plan.
Please mark each section to indicate your understanding/consent.

1. The physical rehabilitation evaluation may include measurement and/or observation of one or more of the following: weight, heart rate, respiratory rate, temperature, limb muscle girth, lameness, range of motion, pain, reflexes, sensation, neurological reactions, and/or functional abilities. The result of this evaluation, including rehabilitation goals and recommendations for additional sessions, will be communicated to you and the referring veterinarian following this evaluation. *

I have read and understand

2. Physical rehabilitation treatment sessions might include one or more of the following procedures: therapeutic exercise, functional facilitation (including assistance with walking, trotting, stair climbing, standing, sitting, and transitions), passive range of motion, joint mobilization (for improved joint mobility), neuromuscular re-education and facilitation techniques (for recovery of neurological function and balance), massage and soft tissue mobilization, and/or assistive device prescription/fabrication. *

I have read and understand

3. I understand that underwater treadmill walking and/or swimming, is sometimes required for rehabilitation of certain injuries. I am aware that my pet will only be towel-dried and will be damp following this procedure. I give my consent to Kathryn Carlson, DVM and/or the staff of Aquapaws to perform aquatic therapy with my pet as required, in the sole judgment of Kathryn Carlson, DVM and/or Aquapaws to facilitate treatment. *

I have read and understand

4. I understand that when indicated, Kathryn Carlson, DVM and/or the staff of Aquapaws may have to restrain my pet or use a muzzle in order to protect my pet and the staff. I give my consent to use restraint as required, in the sole judgment of Kathryn Carlson, DVM and/or Aquapaws, to facilitate treatment. *

I have read and understand

5. I understand that a home rehabilitation program will be designed and explained, if applicable, at the time of my pet’s first rehabilitation session. I also understand that in order for my pet to make steady improvements, daily performance of this home rehabilitation program with my pet is required. *

I have read and understand

6. I understand that photographs and/or video of my pet may be utilized by Kathryn Carlson, DVM and/or Aquapaws for purposes which might include education, outcome assessment, and/or marketing. I give my consent to the staff to utilize these photographs and/or video. *

I have read and understand

7. I understand that if Dr. Carlson is not my primary veterinarian, I will be referred back to my primary veterinarian for assessment following the therapy regimen planned by Dr. Carlson. If further medical treatment is needed during the therapy regime, I will return to my primary or referring veterinarian for care. Dr. Carlson will require follow-up medical recheck visits with the referring, or primary veterinarian. *

I have read and understand

Digital Signature *

Please contact Aquapaws by phone at 760-564-3833 with any questions.

Date *

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