Pet Consultation Questionnaire

Pet Consultation Questionnaire

Northern Hound Holistic
This is a request for services. Payment is not due at this time. Requests are processed within 3-5 working days and a welcome package will be sent to you.

Business hours are: Tuesday-Friday 10:00 AM-2:00 PM MST.

Closed Saturday, Sunday, Monday and all major holidays
For a limited time, we’re offering special introductory pricing on all services! These prices reflect a significant discount and won’t last long, so take advantage of this opportunity to receive premium support for your pet at an unbeatable value. Please note that these prices will be adjusted in the future. No payment is required at this time—simply choose your preferred package, and additional recommendations may be provided at a later stage. Service requests will be processed within 3-5

1. Initial Consultation and Wellness Plan. Price: $50. Includes: One-time consultation and personalized wellness plan tailored to the pet's needs.Note: This consultation is conducted online via ZoomConsultation with 1-Month Continued Support. Price: $80Includes: Initial consultation, personalized wellness plan, plus 1 month of follow-up support (up to 2 follow-up sessions or email support). Note: This consultation and continued support are conducted online via Zoom.Consultation with 2-Month Continued Support. Price: $110Includes: Initial consultation, personalized wellness plan, plus 2 months of follow-up support (up to 4 follow-up sessions or email support). Note: This consultation and continued support are conducted online via Zoom.
Owner's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian Name
How did you hear about us?
Pets name*
Sex*

MaleFemale
Species*

DogCat
Is your pet spayed/neutered*

YesNo
If yes, at what age was your pet spayed/neutered
What age was your pet brought in to your home?*
Breed*
Age*
Weight in pounds*
Coat colour*
Please provide details about your dog's current diet or food brand, including the specific product line and the protein source used. Additionally, if there have been any issues with previous brands or products, kindly specify the brand, product line, and the protein source that caused these issues.*
Are there any foods that your pet is unable to tolerate? If so, what reactions does your pet have to them?
Describe your pets current condition*

Under weightPerfect weightSlightly over weightSeverely overweight
Do you find it challenging to maintain your pet's weight, or to help them lose/gain weight? If so, could you please explain the difficulties you've encountered in this regard?
What issues have you been experiencing with your pet?*
For how long have you been experiencing these issues?*
What steps have you taken at home to address the issue(s), and have they been effective?*
What medical care has your pet undergone in relation to the problem?*
Please provide a list of all medications your pet is currently taking, including the dosage, duration of use, and whether they have been effective.*
Has your pet ever received antibiotics? If so, were any measures taken to restore their microbiome afterwards?
Please provide details of any supplements your pet is currently taking, including fish oil, herbs, remedies, etc., along with the dosage and duration of use.
Please provide details of any additional health conditions your pet has experienced since their puppy hood/kitten hood, if any.
Are there specific times of the day, year, or environmental factors that seem to affect your pet's well-being positively or negatively?
What type of exercise does your pet get? and how often?
Do particular activities or exercise impact your pet's well-being? Please indicate by checking the applicable boxes below.

Change in appetiteVomitingChange in stools or urinePantingCoughingWeaknessDisorientationChange in water consumptionChange in personalityDiarrhea
Please provide further details regarding the issues you've checked above
Could you please provide your pet's vaccination history? Additionally, was your pet detoxed with Thuja after any vaccines were administered? Please list the types of vaccines your pet has received, along with their respective dates if possible.
Has your pet ever undergone anesthesia? If yes, could you please specify the reason or procedure for which anesthesia was administered?
Does your pet have a preference for cooler or warmer areas? Additionally, does your pet prefer soft or hard surfaces?
Has your pet ever had abnormal lab test results? If yes, could you please provide an explanation? If you have a copy of the lab results, please provide them below.
Upload Lab results here

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Does your pet exhibit any unusual behaviours? If yes, could you please provide further details and explanations?
Does your pet have nightmares or trouble sleeping
What other pets reside in your household?
How does your pet interact with the other animals in your household?
Have there been any recent changes in either your or your pet's schedule or life?
What specific questions or concerns do you have that you hope to address during this consultation?
TRADITIONAL CHINESE MEDICINE

Pet personality
This section of our Pet Consultation form is designed to help determine the most appropriate course of action for your pet based on Traditional Chinese Medicine principles. Please read through all five categories and their associated traits, then check the boxes next to the features that best describe your pet, both the positive and negative. Select all that apply.
Fire Element

LivelyInsomniaVery friendlyTongue ulcerationsLoves to be pettedExcess heatAffectionateSeparation anxietyLife of the partyScared with no reasonCommunicativeHeart ProblemsHigh energyRestlessness
Water Element

CarefulRear end weaknessCuriousFearfulSelf containedBone & back issuesLikes to hideUrinary problemsMeditativeDisturbed growthsSlow & consistentDeafnessCautiousReproductive issues
Earth Element

Relaxed and laid backWorriessociableDiarrheaSerine and balanceConstipationCares for others(nurturing)Loss of appetiteLoyalGum diseaseDependableOvereats / obeseSupportiveWeak musclesRound & largeVomits
Wood Element

DecisiveLiver problemsAssertiveSeizuresDominantQuick to angerStrongLigament issuesAlpha animalAnal gland issuesImpulsiveNail problemsAthletic staminaEar problemsConfidentEye issues
Metal Element

Good hair/coatBreathing disorderObeys the rulesSinus problemsAloofDry skinSymmetrical BodyAsthmaDisciplined attitudeNose problemsLoves orderCough
Please provide any additional Information you would like me to know prior to our consultation.
Please provide any files, photos, or documents essential for your consultation, including images of your pet lab records, urine tests, or blood results, food or environmental sensitivity tests.

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Disclaimer for Northern Hound Holistic: At Northern Hound Holistic, our mission is to provide comprehensive guidance and support for the holistic health of your cherished pets. We recognize the significance of transparency and understanding in our services. Our consultations are intended to offer educational insights and recommendations to enhance your pet's overall well-being. We focus on nutrition, supplementation, and lifestyle strategies to complement your efforts in caring for your pet. It's crucial to note that while we provide valuable information, our consultations are not a substitute for professional veterinary diagnosis or treatment. While we strive to provide holistic support, our consultations do not replace the expertise of a licensed veterinarian. Our services do not include treating, diagnosing, or curing medical conditions. We emphasize the importance of continued collaboration with your veterinarian for specific health concerns or medical issues your pet may encounter. Your veterinarian's diagnosis, prescriptions, and procedures remain essential components of your pet's care. We advocate for a collaborative approach to pet health that integrates holistic and veterinary perspectives. Our recommendations are designed to complement the diagnostic procedures and treatments prescribed by your veterinarian. By working together, we can ensure your pet receives the most comprehensive and personalized care possible. By engaging with Northern Hound Holistic, you acknowledge the boundaries of holistic pet care. While we provide valuable insights and support, we do not replace the expertise of veterinary professionals. It's vital to maintain a balanced approach to your pet's health, incorporating both holistic and veterinary care as necessary.*

Yes, I agreeNo, I do not agree
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Your submitted request will be processed within 3-5 business days. Upon acceptance of your request, a welcome package will be emailed to you.

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Pet Consultation Questionnaire

TRADITIONAL CHINESE MEDICINE