Client Rehabilitation Form What are your goals for rehabilitation for your pet: More comfortable from arthritis Better function/stronger Return to backyard games (ball playing, running with you) Weight loss Other If OtherHonestly, how much time per day/ per week can you devote to rehab (we will adjust “homework” accordingly, so be honest.) 20 minutes - 2x/day 20 minutes daily 20 minutes every other day 20 minutess weekly Who in the household will be responsible for rehab?Do you have children? What ages? Will they be a part of rehab at home?Knowing your abilities and limitations help me create a home plan that is realistic for your pet. Protecting your body while working with your dog, is just as important as the exercises themselves. I can: Get on (and off) the floor with my dog Kneel and work with my dog without pain Walk my pet in uneven terrain Lift the front of my dog onto the couch Bend over my pet comfortably for 2 minutes while standing Does your pet have any behavior issues we should know about?How often to you usually leash walk you dog? Daily 1-2 times per week Rarely Is your dog leash trained (ie can he/she walk at heel?) Yes No Are there stairs in your house, or to go out to go the bathroom? If so, how many?Does your dog sleep on the bed? Yes No Is your dog allowed on the furniture? Yes No NameThis field is for validation purposes and should be left unchanged.