The information form is to advise the client of the therapist's qualifications and authorized scope of practice. The following information must be furnished to the client in writing prior to or at the time of the initial visit and signed by the client.

(1) Therapist's qualifications, including:

(a) Education; and

(b) State certification number and date of issue.

(2) A statement that the therapist is limited to providing massage solely for purposes of animal well-being.

(3) A statement that the therapist may not:

(a) Diagnose, prognose, or treat diseases, deformities, defects, wounds, or injuries;

(b) Adjust or manipulate any articulations of the animal's body or spine;

(c) Perform acupuncture; or

(d) Perform mechanical therapies that are restricted to the field of veterinary medicine.

(4) A copy of the signed information form must be maintained in the animal's record.