Inna Vet Initial Questionnaire - Please take the time to read, then click all the required fields. If you have any questions, please let us know.

Inna Vet Initial Questionnaire - Please take the time to read, then click all the required fields. If you have any questions, please let us know.
I understand that Inna Magner, DVM is a licensed veterinarian. Dr. Magner provides: Veterinary Medicine including Acupuncture, Advanced Acupuncture, TCVM, Herbal Medicine, Food Therapy Consultation, Healthy Pet Wellness Checkups, Pain Management, Tui-Na, Integrative Cancer Care, at Home Euthanasia, Routine lab work, Vaccine and Vaccine titers. *

I understand
I understand that I should I maintain my relationship with my regular family veterinarian for routine and emergency care. Inna Veterinary Acupuncture does not offer hospitalization, urgent care, surgery, dentistry, or radiography.and will refer you back to your regular veterinarian if these are needed or desired. I understand that Integrative Care is not a substitute but is a complement to routine veterinary care, including dental care. *

I understand
I understand that my own participation is essential in helping my pet. This includes but is not limited to providing appropriate, physical, emotional, spiritual, nutritional support and routine medical care for my pet. *

I understand
I understand that I am responsible for restraining and monitoring my pet during acupuncture so that the needles are not pulled out, eaten, or shaken out. (During COVID9 protocols, this only pertains to house calls.) *

I understand
I understand that animal practitioners always maintain the Hippocratic Oath to "above all else, do no harm" and work with the animals, not against them. This may mean that for some sensitive animals, subtle energetic techniques may be more appropriate than others. Remember: each session is individual and may involve fewer or more needles or different treatment options and be longer or shorter than other sessions. *

I understand
I understand that Inna Veterinary Acupuncture always does her best to help patients and there is never a guarantee as to the outcome. *

I understand
I understand that if my pet is to receive any medications, herbals, and/or supplements, a current doctor/patient relationship must be maintained by having an exam at least once every six months. *

I agree
Let's get real about cancellations. Stuff happens. It rains, we get sick, we want to flake off and hike or whatever. To stay in business and help pets for years to come, we need you to show up for your scheduled in clinic appointments or be available at the time of your scheduled appointment. We schedule 60 minute appointments not including travel time, so if you cancel in less than 48 hours, we won't be able to fill your time with someone else. Which means we sit around and wait when we could have been helping another animal. We charge $85.00 when you no show or late to cancel your appointment (less than 48 hours notice). Thank you for your understanding and consideration. By typing your full name below, you are agreeing to this charge and are giving us permission to charge your credit card or agree to pay this cancellation fee prior to your next visit. *

I understand and agree
Clients Name *

First Name Last Name
Address (Required for In Home visits)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email Address *
example@example.com
Phone Number *

Area Code Phone Number
Name of your pet *
Breed *
Age *
Sex *

Male Female
Spayed/Neutered *

Yes No
What is the main reason you have reached out to us? *
If you were referred to us, please let us know by whom
Name of current Clinic or Veterinarian *
Phone Number of current Clinic or Veterinarian (for acquiring records) *

Area Code Phone Number
What are you hoping to achieve during our sessions? *
Has your pet had any Integrative Veterinary Care before? (Herbs, Acupuncture, Laser, Ozone or other) If yes, please describe below. *
What therapy modality are you most interested to learn about? *
Patient History

Please fill out to the best of your knowledge all information
How long have you had your pet? *
How old was your pet when he/she was adopted? *
Where was your pet obtained or adopted? *
How does your pet interact with other pets? (Family pets and non familiar pets) *
How does your pet interact with strangers? *
Any recent behavior changes? (If yes, please describe) *
Has your pet gone under anesthesia recently or had any surgeries? (If yes, please describe and include when.) *
What does your pet eat? (Please describe portion and frequency as well as any snacks/treats.) *
Any dietary restrictions or known food allergies? (If yes, please list) *
Any recent dietary changes? (If yes, please explain) *
Any recent changes in food or water intake? (If yes, please explain) *
Please list all current medications and supplements your pet is taking. *
Please describe your pets current energy level. (Very active, active, sedentary, lethargic.) *
Current medical illnesses. *
Past medical illnesses. *
Has your pet experienced any recent trauma? (If yes, please describe.) *
Does you pet need any assistance with: *

Steps Stairs Getting in and out of the car Getting up from a sitting position Does not need any assistance
Please attach the last 6 months of medical records.

Browse Files

Cancel of
Full name: By typing your full name here you agree to everything on the form. This will be considered legal and binding as your original signature.

First Name Last Name
Should be Empty:

Inna Vet Initial Questionnaire - Please take the time to read, then click all the required fields. If you have any questions, please let us know.

Patient History