Animal treatment form

Please take your time to carefully fill out the medical history form. It is a very important basis for your first treatment of your animal in our practice. If you do not wish to provide certain personal information in writing, you are free to do so. Your information will of course be treated confidentially and is subject to medical confidentiality.
Thank you very much, IHR-CHIROPRAKTOR Team
(Fields marked with * are required)

Details of the animal owner

Details of the animal

Current complaints of your animal

Health background of your animal

For female animals:

Lifestyle

For dogs:

Data Protection * (more information)

Knowledge and conscience Headline *