2026 Greenleaf Consultation Intake Form

Greenleaf Consultation Intake Form

Thank you for choosing Greenwood Veterinary House Call Services to explore the potential benefits of cannabis therapy for your pet. This form helps us gather important details about your pet's health and needs, so we can provide personalized guidance and support. Please complete the form to the best of your ability before your consultation.
Consent

Prior to our consultation it is important to understand the legal status of cannabis in Canada in regards to the treatment of animals. Please read the following carefully.
Although cannabis can be legally purchased by any Canadian adult, there are currently no cannabis products available that are approved for use in animals. Veterinarians are not legally permitted to prescribe, dispense, or administer cannabis to our patients. We can, however, provide guidance and recommendations for specific products that can be purchased legally through provincially licensed cannabis retailers. These products are intended for human use, and while they are required to undergo a level of testing for content and purity, there remains the possibility of significant variability between products and batches. Our consultations are intended to allow us an opportunity to better understand your pet's indivdual needs, the role that cannabis may play in their condition, to review and discuss any possible risks or drug interactions, and then recommend one or more products that would be most suitable, along wtih guidance on dosing, monitoring, and follow-up.
Greenwood Veterinary House Call Services has a personal information policy in accordance with the requirements of the Personal Information and Electronic Documents Act. This information is used to maintain complete and accurate client files; provide goods and services to veterinary clients, including contacting clients to schedule appointments and follow-up on patient treatment, billing for goods and services and notifying clients about new services and promotional offers; and communicating and working with third parties providing veterinary medical or other services to clients, including other veterinary facilities and insurance companies which may pay for all or part of the cost of such services. This information will not be used or disclosed for purposes other than those for which it was collected, except with my consent, or except where use of disclosure is required by law.
I'm interested in cannabis for my pet because (check all that apply):
My experience and knowledge regarding cannabis can be best descrbied by which of the following?
Your Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
This email will be used to send follow-up communications and is part of your pet's medical record. It will not be shared with anyone outside of your pet's care team. Providing your email here serves as consent for us to use it to contact you.
How You Would Prefer We Contact You
While we strive to honour your preferred method of communication, there may be times when we reach out using an alternative method to ensure timely and effective communication.
Your Pet's Information
Pet's Name
Pet's Gender
Pet's Species
Pet's Breed
Pet's Age
If you are not sure, please provide your best estimate
Pet's Colour
Pet's Weight
If you are not sure, please provide your best estimate
Please specify
Your Pet's Medical Information
Who is your pet's primary care veterinarian/veterinary practice?
For what condition are you requesting a cannabis consultation (one or more conditions may be selected)
You selected "Other". Please specify below.
Does your pet currently have any other conditions, or a history of any other health issues? Please describe.
Please list all of your pet's current treatments including all medications and supplements, along with their current doses.
Please describe your pet's diet.
Please include the type of food (such as dry, canned, home-cooked, commercial raw, etc.), as well as the amount fed and feeding schedule.
Additional Details to Help Tailor Your Pet's Plan

These questions help us understand how your pet has responded to medications in the past and what works best for your family at home. There are no right or wrong answers — every pet (and person!) is unique.
Gastrointestinal Sensitivity: Has your pet ever had a sensitive stomach (e.g., vomiting, soft stools, or diarrhea) - either in general, or when starting a new food or medication?
Previous Sedatives or Pain Medications: Has your pet ever been prescribed sedatives, pain relievers, or anticonvulsants such as gabapentin, trazodone, tramadol, phenobarbital, etc.?
How did your pet seem to respond to those medications?

Other
If you noticed something other than the options above, please describe what you noticed.
If you recall, what was the medication that caused the above symptoms. (If you don't recall the name, what was it prescribed for?)
Previous Cannabis Exposure: Has your pet ever been given a cannabis or hemp product before (either with veterinary guidance or on your own)?
Please provide the product name or type (if known) of your pet's previous cannabis/hemp product. If you're unsure of the details, tell us what you do remember. (ie. Was it a pet CBD Product? A licensed, human product? Something you purchased online?)
If you recall, please tell us how much and how frequently your pet received a cannabis product.
When was your pet's last dose of cannabis/CBD? (This helps us avoid overlap and adjust starting doses safely.)
Food Motivation: How food-motivated is your pet?
Medication Administration: How comfortable are you giving your pet medication directly by mouth (without food)? This helps us provide guidance on the best administration methods.
Comfort Monitoring: Some pets can experience mild, short-lived effects (like drowsiness or softer stools) when starting new treatments. How comfortable do you feel monitoring your pet at home if something like this occurs? (This helps us decide how gently or quickly to adjust your pet's treatment plan.)
Insurance Coverage
If you have pet insurance, please provide the name of your insurance company and your pet's policy number if you would like us to complete an insurance claim form following your consultation.
Should be Empty:

Greenleaf Consultation Intake Form

Consent

Your Information

Your Pet's Information

Your Pet's Medical Information

Additional Details to Help Tailor Your Pet's Plan

Insurance Coverage