Client Forms

Intake & Release Forms

Please Note:  Release Forms and forms associated with appointment record-keeping are required as part of our Washington State Small Animal Massage Practitioner Licensing.

We would like to thank you in advance for your timely submission of these forms.

Form Instructions & Guidelines

  • Complete the following On-Line  Steady Companion New Patient Intake Form to the best of your ability.
  • Choose Between Two On-line Form Options:
    • Single Card Per Question Option
    • Single Page With All Questions Format
    • Or, You can Download the PDF or Word Version of Each Form Below.
  • Access Form Using Password Provided in Your Appointment Confirmation Email.
  • Review and accept the Terms of Service, Consent & Release statement.
  • Submit the completed on-line form no later than 24 hours prior to your animal’s scheduled appointment.
    • This allows sufficient time for us to review the form, and identify any follow-up questions in advance of your scheduled appointment.
  • We request your transparency in terms of any known medical conditions, behavior issues, etc.
    • We work with intact animals, as well as animals with behavior challenges, bite histories, and fear of Veterinary situations.
    • This will allow us to create a plan to work most effectively, and successfully, with you and your animal.
  • All questions pertaining to a recent illness, injury or surgery are to confirm your animal is no longer experiencing any contraindications, has the appropriate Veterinary release, and able to receive body or energy work services.
  • If your animal has been diagnosed with a chronic condition, we may require a release from your primary or Specialist Veterinarian prior to working with your animal.
     Client Forms – On-Line Form       

Client Intake & Terms of Service

Client Intake Form
  • Pet Owner's Information
  • Animal Client's Information
  • Veterinary Contact Information
  • Treatment Goals & Objectives
  • Pet's General Health & Lifestyle
  • Health History & Current or Past Issues
  • Terms of Service & Release of Liability

Pet Owner's Information


Animal Client's Information


Veterinary Contact Information


Treatment Goals & Objectives

Goals & Objectives Owner Would Like to Achieve. Summarize primary complaints or issues:


Pet's General Health & Lifestyle

List information about general health, lifestyle (including activity level), diet/nutrition/supplements, etc. 


Health History & Current or Past Issues

Include any regular medications, current or past treatment, illnesses, injuries, surgeries, etc.:


Terms of Service & Release of Liability

Disclosure Statement / Terms of Service:
I, Cheri Wildes, am not a Veterinarian. I do not diagnose or treat medical issues, wounds, injuries, offer medical advice, prescribe drugs, perform surgery or other mechanical therapies restricted to the field of Veterinary medicine. I also do not, adjust or manipulate the animal’s body or spine, or perform Acupuncture.

My role is that of a holistic Practitioner. My services are solely for the purposes of supporting the animal’s overall well-being, and to assist the animal to attain and maintain a naturally healthy state. The specific results of Body or Energy Work or Swim Therapy sessions will be different for each animal.

Release of Liability & Consent:
I have read and understand the above Disclosure Statement and Terms of Service regarding the services to be given to my animal(s) by Cheri Wildes of Steady Companion/All Around Dogs Canine Wellness.

I understand that Cheri Wildes is not a Veterinarian, that the services given are not to be considered as Veterinary medical treatment, and the comments, suggestions and recommendations offered during this service are not to be construed as Veterinary medical advice.

Body or Energy Work, including Swim Therapy, and other holistic modalities are not a substitute for Veterinary medical care, but rather a cooperative form of therapy.

I consent that I wish to have these services for my animal(s), and acknowledge I am agreeing in compliance with the Washington State Veterinary Practice Act.

I certify that my animal(s) have received regular Veterinary care and vaccinations, as needed.

I acknowledge that I have read and fully understand the previous statements and consent to Cheri Wildes of Steady Companion/All Around Dogs Canine Wellness performing Body & Energy Work or Swim Therapy Services or other holistic modalities as outlined above on my animal(s).

I understand by agreeing to these terms I am waiving any and all claims I may have against Cheri Wildes of Steady Companion/All Around Dogs Canine Wellness.


Sign Here

     Client Forms – PDF & Word Versions

Client Intake & Terms of Service

Client Intake Form

PDF Format

Access Form Here:

Client Intake Form

Type or Hand Write Responses Email to Address Provided on the Form Within 24 Hour of Scheduled Appointment.

i

Terms of Service Form

PDF Format

Access Form Here:

Terms of Service Form

Type or Hand Write Responses Email to Address Provided on the Form Within 24 Hour of Scheduled Appointment.

Client Intake Form

Word Format

Access Form Here:

Client Intake Form

Type or Hand Write Responses Email to Address Provided on the Form Within 24 Hour of Scheduled Appointment.

i

Terms of Service Form

Word Format

Access Form Here:

Terms of Service Form

Type or Hand Write Responses Email to Address Provided on the Form Within 24 Hour of Scheduled Appointment.

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