Owner *

First Name

Last Name

Home Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Co-Owner (if applicable)

First Name

Last Name

Co-Owner Phone

(###)

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Primary Veterinarian *

First Name

Last Name

Phone

(###)

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Additional Vet (if applicable)

First Name

Last Name

Phone

(###)

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Informed Consent *

Informed Consent: I, the undersigned, do hereby acknowledge that I understand that the bodywork techniques used (Bowen, WEBB, Craniosacral, kinesiology tapings) used during my dog's session work to assist their body into a healthier state. I acknowledge that bodywork does not replace veterinary diagnosis or care. I agree to seek licensed veterinary care for any health concerns I have. I hereby voluntarily consent to having bodywork performed on my dog by the Certified Practitioners of North of 9 Equine & Canine Bodywork

First Name

Last Name

Payment Agreement *

I acknowledge that I have received and reviewed the current rates for my pet's bodywork session.I acknowledge that payment is due within 30 days of my billing date and subject to a late payment fee of $25 per month. Payment options include cash, e-transfer (office@northof9bodywork.ca) or credit card (Invoice link)

First Name

Last Name