Rehab Waiver Owner * First Name Last Name Email * Pet's Name * Phone * Email * Physical rehabilitation and/or an exercise program is a joint venture between the pet owner(s) and the Canine Rehab program at Pend Oreille Veterinary Service. Pet owners are to take responsibility for their part and make a commitment to the recovery process and/or exercise program of the treated pet. This commitment includes attending all scheduled appointments, performing home exercises as assigned, and keeping open communication 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 I state the following: * My primary veterinarian is aware that I am pursuing physical rehabilitation and/or starting a therapeutic exercise program for my pet and has cleared my pet for such activities. I have given permission for the above-named facility to request my pet’s medical history, so as to obtain accurate medical records. * I acknowledge that a person trained in canine physical rehabilitation has discussed treatment with me and has advised me of the risks and contraindications associated with the treatment of my pet. I understand that in some instances, certain conditions including but not limited to neck pain of unknown etiology, certain types of cancer, diagnosed or undiagnosed, may be exacerbated or worsened by aspects of physical rehabilitation. I have been informed 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 to me by the facility. I have had an opportunity to have any and all of my questions answered. * I understand that canine physical rehabilitation is a new and evolving field, and no guarantees have been made regarding the results that may be obtained. *Any rehabilitation equipment provided by the facility is for the sole purpose of use with my pet, and not for human use. I also understand that said equipment is used by my pet at my own risk after appropriate demonstration and instruction in its use by the above-named facility. * I understand that the facility reserves the right to refuse my pet for physical rehabilitation and/or an exercise program, especially if it is deemed dangerous to the staff of the facility, to my pet, the owner, and/or individuals accompanying the pet 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. I have read the above and accept these conditions and my responsibility. Thank you!
