Equine, Canine, and Other species intake forms for Animal Chiropractic Patients

Please enter only one animal patient per form entry

The forms below are the animal patient intakes for each animal. Each form is loaded into the animal's profile for notes and their patient records. To enter another animal, please click here after your previous entry has been confirmed.

*Below are the Equine, Canine, and Other species intake forms. Please fill out the appropriate species intake.*

Equine Intake Form

Equine Intake Form:

  • We enter the owners information, like date of birth, into our electronic health records for accurate information. If no date is provided, we use the date of initial service. This information is used when scheduling online for human chiropractic visits.
  • Where the animal is stabled/resides at.
  • Date Format: MM slash DD slash YYYY
  • :

Canine Intake Form

Canine Intake Form:

  • We enter the owners information, like date of birth, into our electronic health records for accurate information. If no date is provided, we use the date of initial service. This information is used when scheduling online for human chiropractic visits.
  • Date Format: MM slash DD slash YYYY
  • :

Other Species Intake Form

Other Species Intake Form:

  • We enter the owners information, like date of birth, into our electronic health records for accurate information. If no date is provided, we use the date of initial service. This information is used when scheduling online for human chiropractic visits.
  • Name of the animal or a way to identify
  • Where the animal is stabled/resides at.
  • Date Format: MM slash DD slash YYYY
  • :
  • For Chiropractic visits for animals other than equine and canine, the treating vet is required to be present during the treatment.