Pet Owner's Name
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Date
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Phone Number
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Email Address
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Pet's Name
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Pet's Species
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Pet's Gender
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Current Age of Pet
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Age of pet when adopted?
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Color
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Weight
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Has the Pet Been Spayed/Neutered? Other (Hormone Therapy, Ovary Sparing Spay/Vesectomy?)
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Spayed/Neutered Age?
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Primary health concerns/symptoms how long your pet has been experiencing each concern:
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What Have You Done at Home for the Problem(s)? Has it Been Effective?
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What Medical Treatment has Your Pet Received Related to the Issue?
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Please Include All Current Medications / Dose / How Long Taking it / Results?
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What are You Currently Feeding Your Pet?
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Any Foods That Your Pet Cannnot Tolerate? What's Your Pet's Reaction to it?
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List All Supplements being Given to Your Pet (Brand/Lenth of time approx.)
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List Any Other Health Conditions Your Pet has Experienced from Puppyhood/Kittenhood Forward.
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Is there Any Specific Time of the Day/Year or Other Environmental Factor that Makes your Pet Feel Better or Worse?
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What Type of Exercise does Your Pet Get & How Often?
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Does Exercise or Certain Activities Make Your Pet Feel Better or Worse? If So, Describe in Detail
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Have you noticed any of the following? Change in Appetite, Lethargy, Vomiting, Change in stools, Panting, Coughting, Weakness, Disorientation, Change in Water consumption, Change in Personality?
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Is it Hard to Maintain Your Pet's Weight or Make them Lose/Gain Weight? Please Explain.
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Please Provide Your Pet's Vaccine History. Any Detox Method(s) Applied?
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Has Your Pet Ever Been Anesthetized? If So, For What & How Long Ago?
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Does Your Pet Prefer Cool or Warm Areas? Soft or Hard Surface?
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Has Your Pet Had Abnormal Lab Tests? If Yes, Please Explain
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Does Your Pet Have Unique or Strange Behaviors? If So, Please Explain.
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Does Your Pet Have Nightmares or Trouble Sleeping?
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Any Other Pets In Your Household?
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How Does This Pet Interact With Your Other Pets?
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Has There Been Any Changes In Your Pet's Schedule or Life?
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What Are The Questions You Hope To Have Answered In This Consultation?
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What Are Your Goals For Your Pet's Day-To-Day Activities? Long Term or Short Term?*
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Pet's Primary Care Veterinarian & Contact Info
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Are you careful about decreasing your pet's toxin load? (Feeding organic, giving water from a high quality water purifier, eliminating chemicals in shampoos and cleaning supplies, etc.)
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Please describe your pet's exercise routines.
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Other Concerns or things I should be aware of:
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