Contact Information

Contact Information
First Name
Last Name
Email
example@example.com
Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Date
Pet Information
Pet's name
Breed
Age
Weight
Sex
Pet's Details
What problem(s) are your pet's experiencing?
When did you notice the problem(s)?
What have you done at home for the problem(s)? Has it been effective?
What medical treatment has your pet received related to the issue
Please include all currentmedications / dose / how longtaking it / was it helpful?
Please list all supplements being given to pet.
( fish oil, herbs, remedies, etc | dose and how long taking it
What are you currently feeding your pet?
Any foods that your pet cannot tolerate? what's your pet's reaction to it
Please list any other health conditions your pet has experienced from puppyhood/kittenhood forward?
Is there any time of the day/year or other environmental factor that makes your pet feel better/worse
What type of exercise does your pet get? and how often?
Does exercise or certain activities make your pet feel better/worse? If so, please describe.
Does exercise or certain activities make your pet feel better/worse? If so, please describe.

Change in appetiteVomitingChange in stools or urinePantingCoughingWeaknessDisorientationChange in water consumptionChange in personalityHave you noticed any of the following?
Change in personality
Please explain any checked issues above
Is it hard to maintain your pets weight, or make them lose/gain weight? Please explain
Please provide your pet's vaccine history. Was Thuja or Lyssin used after vaccines?
(List types of vaccines and dates if possible)
Has your pet ever been anesthetized? If so, for what?
Please include any issues with recovery from anesthesia.
Does your pet prefer cool or warm areas? Soft or hard surfaces
Has your pet had abnormal lab tests? If so, please explain.
Does your pet have strange behaviors? If so, please explain.
Does your pet have nightmares or trouble sleeping
What are other pets in your household?
How does this pet interact with them?
Have there been any changes in your or your pet’s schedule or life
What are the questions you hope to be answered in this consultation?
What are your goals for your pet's day to day activities? Long term or short term?
Chinese Pet Personality
This portion of our Pet Consultation form package is used to determine which course of action is most appropriate for your pet in terms of Traditional Chinese Medicine. Read through all 5 categories and their traits, mark the boxes of features that relates or describes your pet. Choose all applicable
Fire

livelycommunicativevery friendlyaffectionateloves to be pettedcenter of the partyinsomniaseparation anxietyexcess heatrapid heart rateheart problemsscared with no reasontongue ulceration
Water

carefulcuriousself containedlikes to hidemeditativeslow and consistentrear weaknessfearfulbone and back issuesurinary problemsdisturbed growthsdeafnessreproductive problem
Earth

relax, laid backsociableround and largeloyalserine and balancecares for others (nurturing)diarrheaconstipationloss of appetitevomitgum diseaseweak musclesovereats / obeseworrie
Wood

decisiveassertiveconfidentstrongimpulsiveathletic staminaalpha animalsligament problemsliver problemsred eyesangers easilyear problemsnail problemsanal sack issuesseizuresdominantfearlesshasty
Metal

loves orderobeys the rulealoofsymmetrical bodydisciplined attitudegood haircoatashtmadry skinsinus problemsbreathing disordernose problemscoug
Spayed/Neutered? age?
How old when adopted
Should be Empty:

Contact Information

Pet Information

Pet's Details

Chinese Pet Personality