Customer Consent Form

Name & Contact Number

Email Address

Full Postal Address

Dogs Name, Breed and Age

Dogs Gender and Neuter Status

Notable features i.e. docked tail, cropped ears etc.

Veterinary Practice Name & Veterinary Surgeon

Veterinary Practice Contact Number

Daily Workload i.e. working dog, amount of daily walks etc

Any competitive activities? i.e. Flyball, working trials or showing

Reason for last Vet visit

Any medication? i.e. Prescribed, herbal, supplements, wormed etc

Pin/Plates/Operations?

Last bathed/groomed/nail clip

Type of collar/harness? Does your dog pull on a lead?

Does your dog live inside/outside/have companions?

Any recent changes in routine? i.e. house move/new dog/recently adopted?

Current Injuries/Issues

Lameness (If new lameness, MUST see Vet before work carried out)

Stiffness

Unusual Stance/Movement

Emotional Distress

Performance Issues

Other

If "Other", please explain

Any other physical or emotional issues?

Type of food/appetite/digestion

Any previous/current therapies? What type, why and results

Opt-In

By checking, I understand that YPT sessions do not replace veterinary advice or expertise

Opt-In

By checking, I confirm that my vet is in agreement for my dog to attend YPT sessions

Opt-In

By checking, I confirm that should my dog become ill/injured between gaining vet permission and YPT session, I will inform both parties

Opt-In

By checking, I confirm that by completing this form, this constitutes as my digital signature

Opt-In

By checking, I confirm that I have read and understood YPT T&C's and privacy policy

New Customer Consent Form