Holistic Questionnaire
Pet's name
*
First Name
Last Name
Pet's energy level?
*
Low
Medium
High
Pet prefer's warmth or cold?
*
Warmth/Sunlight
Cold/Cool floor
Major issues/Reason for bringing pet in?
*
Thirst Level
*
Very thirsty
Normal
Less Thirsty
Appetite
*
Ravenous
Normal
Finicky
Feces
*
Dry
Bloody
Stinky
Normal
Loose
Urine
*
Short stream
Bloody
Stinky
Normal
Long stream/Leakage
Sex of Pet
Female Spayed
Male Neutered
Female Intact
Male Intact
Feline or Canine
*
Feline
Canine
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 issues
Wood: 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.
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