Animal Flower Essence Consultation
1. Owner's Details
Owner / carer name
*
Full Name
Relationship to animal
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
2. Animal Profile
Please describe your animal as you know them. Questions may be left blank if not relevant. Behavioural observations are especially helpful.
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Initial consultation
Follow-up
Online
Phone 4
In-person
*
Animal's name
Species (horse, dog cat etc)
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Breed / type
Age or date of birth
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Sex
Desexed? (yes / no / unknown)
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Length of time in your care
Other regular carers
Where did your animal come from? (breeder, rescue, rehoming, etc)
Describe your animal's usual personality, strengths and favourite activities.
3. Reason for Consultation
What are you rmain concerns or reasons for seeking flower essences?
Select as many as you like
*
Fear / nervousness
Separation distress
Change / transition
Confidence
Reactivity
Grief / loss
Social tensions
Other
When did you first notice this? Was there a particular event or change?
What would you most like to see change? How will you recognise progress?
4. Behaviour, Triggers & Responses
Describe the behaviour or emotional signs you observe (what happens, when and how often).
What seems to trigger or worsen these responses (people, animals, sounds, handling, places)
What does your animal do when frightened, unsettled, frustrated or overstimulated?
What helps your animal relax, feel secure or recover after a stressful event?
Have you noticed any changes in appetite, sleep, social interaction or usual behaviour?
5. Home Environment & Relationships
Describe your animal's living environment, daily routine and opportunities for rest and enrichment.
Relationships with people, other animals and any recent additions or losses.
Any changes in housing, carers, travel, routine other other circumstances.
6. Background, Health & Veterinary Care
New, painful, sudden or worsening behaviour may have a medical cause and should be assessed by a veterinarian. Flower essences do not replace veterinary diagnosis or treatment.
Known health conditions, injuries, pain concerns or significant veterinary history.
Current medications, supplements, treatments and existing flower essences.
Veterinarian / veterinary practice and last relevant assessment.
Allergies, sensitivities or ingredients/ administration methods to avoid.
Training behaviour support or other professional services currently involved.
7. Species-Specific Questions
Complete only the sections relevant to your animal
HORSES: Herd dynamics, paddock / stabling, turnout, feeding routine, separation and transport.
HORSES: Handling, grooming, farrier, vet visits, riding / training and any observed tension.
DOGS: Walks, leash behaviour, visitors, alone time, other dogs and household routines.
CATS: Territory, hiding, litter habits, mult-cat relationships and environmental changes.
OTHER SPECIES: Housing, social needs, handling, enrichment and species-specific stressors.
8. Previous Experience & Preference
If previously used, which flower essences or blends, and what did you observe?
Preferred way to offer a preparation and any practical considerations.
Signature
*
Date
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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