Rehab Agreement/Waiver Rehab Waiver Owner(Required) First Last Pet's Name(Required) Phone(Required)Email(Required) Physical rehabilitation and/or an exercise program is a joint venture between the petowner(s) and the Canine Rehab program at Pend Oreille Veterinary Service. Pet ownersare to take responsibility for their part and make a commitment to the recovery processand/or exercise program of the treated pet. This commitment includes attending allscheduled appointments, performing home exercises as assigned, and keeping opencommunication regarding progress or changes in the pet’s condition/recovery.I would like my pet treated at the above-named facility. In support of that treatment Istate the following: My primary veterinarian is aware that I am pursuing physical rehabilitation and/orstarting a therapeutic exercise program for my pet and has cleared my pet forsuch activities. I have given permission for the above-named facility to requestmy pet’s medical history, so as to obtain accurate medical records.I acknowledge that a person trained in canine physical rehabilitation hasdiscussed treatment with me and has advised me of the risks andcontraindications associated with the treatment of my pet. I understand that insome instances, certain conditions including but not limited to neck pain ofunknown etiology, certain types of cancer, diagnosed or undiagnosed, may beexacerbated or worsened by aspects of physical rehabilitation. I have beeninformed of and am aware of the potential risks involved as they pertain to my pet. I have been given and have read any and all applicable materials presented tome by the facility. I have had an opportunity to have any and all of my questionsanswered. I understand that canine physical rehabilitation is a new and evolving field, andno guarantees have been made regarding the results that may be obtained.Any rehabilitation equipment provided by the facility is for the sole purpose of usewith my pet, and not for human use. I also understand that said equipment isused by my pet at my own risk after appropriate demonstration and instruction inits use by the above-named facility.I understand that the facility reserves the right to refuse my pet for physicalrehabilitation and/or an exercise program, especially if it is deemed dangerous tothe staff of the facility, to my pet, the owner, and/or individuals accompanying thepet to the above-named facility. Optional Video Consent I hereby consent and give permission to Canine Rehab at POVS to publish, produce, or otherwise use photographs and/or videos of my pet for the use of instruction, advertising, or other lawful purposes. This includes but is not limited to the facilities website, social media, and/or marketing materials. I do hereby waive any interest I may have in the finished product and all rights to payment or compensation. Understanding all of the above, I hereby authorize the practitioner/facility and any and all of its employees to provide physical rehabilitation and/or an exercise program for my pet, whatever procedures are deemed necessary.(Required) I have read the above and accept these conditions and my responsibility.