Massage Four Paws

Pomoting your pet's well-being through touch

Massage Four Paws Health Intake Form 

Promoting the well-being of your pet through touch


Client Name: ____________________________________________________________________________________

Address: ________________________________________________________________________________________

City: _________________________________________ State: ___________________ Zip code: _____________

Phone #: ________________________________ Email: _______________________________________________


Veterinarian Information

Clinic Name: ____________________________________________________________________________________

Vet Name: ___________________________________ Phone #: ________________________________________

Address: ________________________________________________________________________________________

City: _________________________________________ State: _____ Zip code: _____________


Pet Information

Pet Name: ____________________________________ Sex: ____ Age: _____ Sp: ___ N: ___ In: _____

Health History/Concerns: _________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Special Needs/Diet/Medications:__________________________________________________________________

__________________________________________________________________________________________________

Training/Activities: _______________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________

Additional Comments/Plan: ______________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Client Signature: __________________________________________ Date of Service: ________________


Massage is not or intended to be a substitute for proper veterinary care