Traditional Chinese Veterinary Medicine Intake
Owner's Name
First Name
Last Name
Pet's Name
Please choose all applicable traits that can be seen in your dog.
Fire
lively
communicative
very friendly
affectionate
loves to be petted
center of the party
insomnia
separation anxiety
restless
excess heat
rapid heart rate
heart problems
Wood
assertive
confident
strong
impulsive
athletic-stamina
alpha animal
ligament problems
liver problems
red eyes
angers easily
ear problems
nail problems
footpad problems
anal sac issues
Earth
relaxed, laid back
sociable
round and large
loyal
serene and balanced
cares for others (motherly)
diarrhea
constipation
loss of appetite
vomits
gum disease
weak muscles
overeats-obese
worries
Water
careful
curious
self contained
likes to hide
meditative
slow and consistent
rear weakness
fearful
bone and back issues
urinary problems
disturbed growth
deafness
reproductive problems
Metal
loves order
obeys the rules
aloof
symmetrical body
disciplined attitude
good haircoat
asthma
dry skin
sinus problems
breathing disorder
nose problems
cough
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