Yard Visit Booking Form - e-quinerehab.com

Details - Step 1 of 4

Organisers Name *

First

Last

Organisers Email *

Organisers Contact Number *

Yard Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Number of horses for treatment

Selected Value: 0

Available Services *

Equine Sports Massage
Equissage
Kinesic Taping
TheraPlate
Zamar Cryotherapy

This will allow us to identify the equipment we need to prepare for the visit

Have you used E-quineRehab.com before? *

Yes
No

Consent

Multiple Choice

IATS

Checkboxes *

I agree to the TheraPlate Consent Form *

* The TheraPlate is not suitable for the treatment of blood clots.

* I understand there may be temporary muscle soreness post therapy.

* I am aware that a TheraPlate therapist does not diagnose illness, perscribe medications,
manipulate the body or give medical advice.

* I am aware that the TheraPlate may help improve certain conditions, however results are
not guaranteed.

* I will tell the TheraPlate therapist of any discomfort during the protocol.

Checkboxes *

I have read and agreed to the below cancellation policy *

Appointment Cancellation

When you book your appointment, you are holding a space on our calendar that is no longer available to our other clients.
In order to be respectful of your fellow patients, please email support@e-quinerehab.com as soon as you know you will not be able to make your appointment.

If cancellation is necessary, we require that you confirm at least 48 hours in advance.

Appointments can be in high demand, and your advanced notice will allow another client access to that appointment time.

How to Cancel Your Appointment

If you need to cancel your appointment, please email us at support@e-quinerehab.com between the hours of 09:00 – 21:00.

Late Cancellations/No-Shows

A cancellation is considered late when the appointment is cancelled less than 48 before the appointed time.

A no-show is when a client misses an appointment without cancelling. In this instance we will debit the cost of the required service from the card used to book the appointment.

Payments

Checkbox Items *

I accept that a booking fee is required and that will be refunded to me on the day of visit if over 10 horses are booked.

Deposit Total

£ 0.00

A deposit is required due to cancellation policy

Credit / debit card number *

Card

Name on Card