Animal Client Intake Form Your answers are completely confidential and help me to serve your pet more efficiently. Please answer as completely as possible. Click NEXT after each entry. – JoyceStep 1 of 812%Owner's Name* First Last It's nice to meet you!Animal Companion's Name First What kind of animal is your companion?*SexMaleFemalePlease choose one.AgeOwner Email* Owner Phone*Owner Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Please list any surgeries your animal companion has experienced and approximate datesPlease list any accidents/injuries your animal companion has experienced, and approximate datesList known stressors for your animal companion*Issues you would like to address in this session:*How did you hear about Joyce?Consent* I have read and agree to the Soaring Spirits LLC Terms and Conditions.I understand that the craniosacral therapy received here is for the purpose of stress reduction, emotional and physical release, re-balancing and increasing energy flow in the body. I understand that Joyce does not diagnose illness, disease, or any other physical or mental disorder. The services provided as set forth herein, are not to be construed as a substitute for professional veterinary care, proper nutrition, exercise or training. I have made her aware of existing conditions and will report any changes as they occur. I agree to have my animal companion receive a biodynamic craniosacral therapy session and I understand that it may take more than one session to affect change. I also understand that my companion may temporarily experience an energy release that may be uncomfortable, and I WILL NOT hold Joyce Harader responsible. I will communicate any observations directly to Joyce. I understand that Joyce is available to me, if questions or further discussion of the session is wanted. I understand that if I need to cancel an appointment, I need to do so with a minimum of 48 hrs. notice. A cancellation with less than 48 hrs. notice will be charged a full appointment fee. I have read and understand the above disclosure statement pertaining to the therapy(s) to be performed on my animal companions. I agree and give my consent for this therapy to be given to my animal(s) until I decide otherwise. I understand that this therapist is not a veterinarian. This is in accordance with the Illinois Veterinary Medicine and Surgery Practice Act of 2004.Your typed name indicates your electronic signature.*Please type your full name.Date MM slash DD slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. It is still beyond me how something so gentle can have such powerful results.– Craniosacral Therapy Kent