Equine New Client Questionnaire

NEW CLIENT QUESTIONNAIRE - EQUINE

Please complete the form with as much information as possible to book an initial appointment.

First Name

Last Name

Phone

Email Address

Home Address

(Please also provide details of how to reach the yard if the postcode is not accurate, or it is not obvious).

Treatment / Yard Address

Animal Details

(Name, Breed, Height, Age, Sex)

Please note that veterinary consent and/or notification will be required before physiotherapy treatment. This will be obtained by NP Vet Physio after submission of this form.

Registered Vet Practice

Is your horse currently undergoing assessmet / review / treament by yor vet AND/OR does your horse have any diagnosed medical conditions?

Yes

If yes, please provide details

(E.g. timescale / treatment provided / reason for visit / medical conditions)

Is your horse currently being given any medications / supplements?

Do you have any current concerns about your horse's health or behaviour?

Terms and Conditions

I consent to the named animal receiving veterinary physiotherapy assessment and treatment by NP Vet Physio in accordance with the terms and conditions below.

1. I have checked and confirm that all details within the new client questionnaire are correct. I take responsibility for any incorrect details and agree to pay a mileage charge if an incorrect address is provided and subsequently attended by NP Vet Physio.

2. I agree to the processing and storage of personal information and data relating to myself and my above-named animal(s) in accordance with GDPR requirements.

3. I agree to NP Vet Physio contacting my veterinary practice or other professionals regarding the named animal’s physiotherapy assessment / treatment as required. Please note that where intended / undertaken after assessment this will be communicated verbally to you.

4. I agree to pay invoices within the outlined payment periods and understand that a late fee of 50p per day will be levied where invoices are overdue. Please note that if you are intending to claim on your insurance you will need to pay NP Vet Physio directly and then request payment to yourself from your insurance. NP Vet Physio is happy to complete necessary insurance forms and provide invoices.

5. I agree to provide at least 24 hours’ notice if I need to cancel an appointment and I understand that cancellation charges will be applied if this is not met. Cancellation Policy (for less than 24 hours' notice): 100% appointment fee if cancelled or failed to attend, 50% non-refundable appointment fee if rescheduled, other than in emergencies where this fee will be deducted from the next session.

I accept the terms and conditions

Thanks for submitting! We will be in touch shortly to arrange an appointment.