Click here to find out more about Canine Fitness Canine Fitness at AMMEC Client Intake Form Name * First Name Last Name Email * Phone (###) ### #### Address Preferred method of communication Text Email Phone call Preferred Learning Styles Check all that apply Visual Auditory Read/Write Kinaesthetic How much time do you think you could devote to this each week? Examples: 10 minutes/day; 3xs to 5xs/week; every other day? Are you comfortable with smartphone technology? Eg camera, apps Yes Not really Pet Profile Pet's Name, Breed, Colour, Weight, Age, Spayed or Neutered (and at what age) Vet or Vet Clinic name and contact details Vet clearance is required to undertake a fitness program My dog is up to date with all vaccines or titers * Yes No If you answered no to vaccines/titers, please provide further details Does your dog have any current issues? Medical, behavioural, other? Yes No If you answered yes, please elaborate further Please list any current or past medications Any past conditions, surgeries and/or accidents Current diet and eating habits, including food sensitivities, if any Does your dog resource guard food? Toys? People? Do YOU have any food allergies? Your dog gets most excited about? Treats? Toys? Praise? Tell me about a typical day with your dog Tell me about an ideal day with your dog Favourite thing to do with your dog? Your dog's favourite thing? How much exercise does your dog usually get daily and over the course of the week Briefly describe training experience and activities you do or have done with your dog Eg Basic Obedience, high level dog sports Are you and your dog familiar with: Luring Shaping Marking and rewarding What are your hopes and goals for your dog? What would you hope to achieve by adding canine fitness to your dog's activities? Eg Generally support optimal health, Improve sport specific skills, gain strength, become more flexible, reduce risk of injury, have a fun thing to do together... Permission to take pictures and video of our sessions Yes, for assessment purposes I also permit respectful use in social media Waiver * I give permission for Bev Spotton to work on and with my pet. I understand that Bev is not a licensed veterinarian and will not diagnose conditions, prescribe medications or perform surgeries. I understand Canine Fitness and Conditioning is not a substitute for veterinary treatment. I give permission for information about my pet, to be exchanged between my veterinarian and/or other members of my pet’s health care team, and Bev, if needed. I understand that a complete history is required for accurate and appropriate treatment of any kind. I understand that full participation by the owner/handler is essential to achieving beneficial results. I understand that I will not hold Bev responsible for any damages to others or damages to property caused by my dog. Finally, by attaching my full name, below, I hereby waive and release Bev Spotton from any and all liability relating to my pet. Date MM DD YYYY Thank you!
