P: 239-263-0480
F: 239-263-0488

10130 Market Street • Naples, FL 34112

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Dog and Cat Physical Rehabilitation in Naples FL
Board certified specialists in Physical Rehabilitation located in Naples FL
Naples FL Board certified specialists in Physical Rehabilitation

Physical Rehabilitation and Fitness Department Online Questionnaire


You can also download our PDF version and fax it / mail it. Download our physical rehabilitation and fitness department online questionnaire here

Please make sure you fill out all required fields (*)

1) Today's date:

2) Your full name: (*)

3) E-mail: (*)

4) Pet's name: (*)

5) Pet's date of birth: (*)

6) His/her age: (*)

7) Breed: (*)

8) Neutered or spayed: (*)

9) Sex: (*)

10) Please tell us what brings you to ASH’s Physical Rehabilitation and Fitness Department (presenting concern for your pet): (*)

11) When did you first notice this problem? (*)

12) What are your goals for your pet? (*)

13) Has a veterinary specialist examined your pet for this issue before? (*)

  • A) If so, which specialist?
  • B) If so, when?

14) Has this problem progressed, stayed the same, improved, or waxed and waned? (*)

15) Any other medical history or concerns such as illnesses, surgeries, injuries, or cancer? (*)

16) What diagnostics has your pet undergone (e.g., radiographs/x-rays, blood work, ultrasound, MRI, CT, etc.)? (*)

17) Has your pet started or undergone any treatments to address this issue? For example, rehabilitation, laser therapy, acupuncture, or chiropractic therapy. (*)

18) What is your pet’s activity level? (*)

19) What medications and/or supplements is your pet currently taking? Please include dosages and frequency. (*)

20) What is your pet’s diet? Does (s)he have allergies or food sensitivities? (*)

21) Does your pet have difficulty urinating or defecating? Or, is (s)he incontinent (i.e., unable to control his/her urine or stool)? Can your pet squat easily or lift his/her leg normally to urinate and defecate? (*)

22) Please describe what pain behaviors your pet exhibit. (For example, crying, licking, panting, limping, pacing, or experiencing restlessness.) (*)

23) Does your pet’s pain or lameness change with weather, exercise, or rest? Please describe. (*)

24) Does (s)he experience difficulty moving around your home? Please include floor and lawn type(s) and whether (s)he encounters stairs, climbs furniture, or uses a dog-door. (*)

Specialty Services


Animal Specialty Hospital of Florida © 2018
10130 Market Street | Naples, FL 34112
P: 239-263-0480
F: 239-263-0488

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