Pet Paws Physio

Your client has requested referral of their pet for physiotherapy by Pet Paws Physio Small Animal Rehabilitation Therapist Deirdre Duggan. Please can you complete referral by filling out this form and attaching the FULL CLINICAL HISTORY. If you have any questions, please do not hesitate to contact me. Many thanks for this referral. Deirdre Duggan Small Animal Rehabilitation Therapist. RVN, Dip. Canine Aqua & Hydrotherapy, Cert. Small Animal Hydrotherapy, P.G. Cert Small Animal Rehabilitation Therapy. Email: petpawsphysio@gmail.com. Tel: 086 3150786 Facebook/Instagram: @petpawsphysio

Client Name

Client Address

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Click to enter an email address

Animal's name

Animal's age and Date of birth

Animal's Breed

Animal's sex , neutered ?

Reason for referral/ diagnosis (Please give details of onset incident/surgery/condition)

Is your pet on any medication? Please give details

Any concurrent conditions

Relevant past medical history/surgeries/injuries

Expected outcome of physiotherapy

To make an appointment, I will need your vet to refer you before I can see your pet. If your vet is happy to refer, they will need to email me the following to petpewsphysio@gmail.com

Referral form- press submit or fill out PDF form and email me form
full clinical history/notes
X-Rays, CT or MRI reports

Name of referring vet and practice

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Click to enter an email address of your vet

User Agreement

I give consent for you to treat this animal with physiotherapy and understand that you will refer to us any concerns you may have. This animal is of fit enough purpose to undergo these treatments.

By pressing submit you agree to this statement