Post - Surgery Consultation Form Post - Surgery Consultation Intake Date Date Format: MM slash DD slash YYYY Patient Name*Surgery and date performed*What medication is your dog currently taking?Please include dosage and frequency.Previous injuries and approximate dates*State "None" if applicableDoes your pet have any dietary restrictions/allergies?*What level activity did your pet have prior to their injruy/surgery?*Highly Active/Working dogModerately Active (walks, hikes, swimming, fetch)Minimally ActiveRealistically, how much time each day or week can you commit to an at home exercise plan?*How is your pet doing at home?*Walking normally, without limpingMild limping, intermittentlyMild limping, consistentlyModerate limping, Using the leg with about 50% normal weight-bearingNot using the leg when walking to slight "toe-touching" onlyWhat exercise are you currently doing with your dog?*Describe any other goals or concerns you have about your pet's recovery?