*Important: Thank you for your interest in animal bodywork. This form is for those interested for their horses or for home visits for their mobility-restricted or reactive dogs.

Please note all other dogs are seen in the Red Bank office of Dr. Kendra Pope and should complete the following form in order to be scheduled.

*Please note it is only necessary to provide one form per owner. Multiple animals may be listed below.

Medical History

Please list any chronic illnesses, lamenesses, allergies, or past surgeries.

Bodywork

*Please note thermal imaging is included in initial massage sessions upon request but may also be provided a la carte for farrier/veterinary purposes.
Please indicate any sensitive areas or behavioral triggers we should be aware of during bodywork.
I hereby give Heather Wallace/Animal Bodywork and Aromatherapy permission to photograph my animal for the purposes of posting on social media channels for promotional or educational purposes.

I understand my personal information will remain private and will not be shared to the public with the exception of my animal's first name and image.
I understand that massage/ aromatherapy/ acupuncture/chiropractic work is not a substitute for medical treatment or medications, and that it is recommended that I work with my veterinarian for any medical conditions that my animal may have. I understand that Heather Wallace, or other non-veterinary associates of Animal Bodywork and Aromatherapy cannot diagnose illness or prescribe medications. I understand that any information provided by the therapist is for educational purposes only, and is not diagnostically prescriptive in nature. I have listed all my animal’s known physical conditions, limitations, medical conditions and medications. It is my responsibility to update this information with the therapist and contact my veterinarian if my animal’s physical condition, limitations, medical condition or medications should change.

By signing this release, I consent to treatment for my animal and hereby release Heather Wallace, ESMT, CST, CCMT, CEE and the independent contractors of Animal Bodywork & Aromatherapy from any and all liability, past, present and future, relating to the bodywork services provided at your request.
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