APA Consultation Form

PLEASE INFORM ME IF YOU OR YOUR ANIMAL is (OR COULD BE) PREGNANT, OR ON MEDICATION.

SOME ESSENTIAL OILS SHOULD BE AVOIDED IN PREGNANCY AND WITH CERTAIN MEDICINES.
Date*

MonthDayYear
Date
Owner's details
Name*
Contact number
Postal Address
E mail*
example@example.com
Animal's details
Name *
Age*
Sex*
Species *
Breed*
WHAT CAN I DO FOR YOU? (describe the current problem, it's history and any treatment, current or past, that has been prescribed by a vet or other holistic practitioner)*
LIFE HISTORY (the more the better)*
Is the condition better or worse at a particular time of day or year?*

LIFESTYLE
Live in or out?*
Where does he/she sleep (dogs and cats)?*
How much free time with his/her own species?*
Diet (please include EVERYTHING you feed with brand names, including treats and when)*
How much physical exercise?*
How much mental exercise (i.e training etc)?*

8 PRINCIPLES

Answer these questions fully with as much detail as you can.
Describe he/her eating habits and appetite*
Describe his/her drinking habits and thirst*
Describe his/her urination habits*
Describe his/her stools*
Describe his/her sleeping habits (and any changes of energy during the day or night)*
Does he/she prefer or have an aversion to cold?*
Does he/she prefer or have an aversion to heat?*
Does he/she have pain in their body?*

ABOUT YOU
Are you the main carer?
Who else lives with you/cares for him or her? And how do they interact.
Please list any health issues you (or other family members) have*
What is you animal experience?*
Have you had help training this animal, if so who with?*
What attracted you to this particular animal (not the breed, the individual)*
What are your hopes and expectations from this animal?*
What do you like the most about this animal?*
What do you like least about this animal?*
What is your basic attitude to life?*
Is their any other information you think will be relevant?*
Upload a recent photo of face and body of animal here*

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Agreement: I understand that essential oils are not a replacement for veterinary care, my veterinarian has seen the animal and diagnosed the problem (where relevant) and I have informed him/her I will be using essential oils. I understand that Nayana may advise changes to diet and other management advice and that if I do not implement the changes I may have less success with the treatment. I agree to use the essential oils only as taught and follow the instructions I have been given. I understand that Nayana Morag is available to answer any questions that I might have and if I am in any doubt I will contact her via email.
Owner's signature*

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My Products

APA consultationA full assessment of meridian balance and advice on how to re-balance with aromatics. Including 40 min Zoom consult

€125.00 Quantity

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