Holistic Questionnaire

Pet's name*

First NameLast Name

Pet's energy level?*

Pet prefer's warmth or cold?*

Major issues/Reason for bringing pet in?*

Thirst Level *

Appetite*

Feces

Urine

Sex of Pet

Female SpayedMale NeuteredFemale IntactMale Intact

Feline or Canine

FelineCanine

Age/Date of Birth*

Food Allergies *

Weight History

Supplements*

Medication*

Current Diet/Food Given *

Please choose the one that best applies to your pet*

Earth: Relaxed, Laid back, Motherly, loyal, Friendly GI Issues, Sweet &Kind, Tolerant.Metal: Loves Order, Obeys the Rules, Aloof, Disciplined Attitude, Good haircoat, Independent, shy, Skin or Lung issuesWood: Competitive, Assertive, Confident, Strong, Impulsive, Athletic Stamina, Bossy, Eye or Ear Issues.Fire: Hyper/Easily excited, noisy/barks a lot, affectionate, loves to be petted, center of the party, separation anxiety,heart issues, sensitive, greets quickly and warmly.Water: Careful, Curious, self contained, likes to hide, meditative, slow and consistent, shy/fearful, urinary issues.