Consultation History From

Please fill out this form as best as you can. This will be very helpful for me in the preparation for our call, and it will save us time so we can spend the time on resolutions to your pet's health issue(s).

No part of this form will become public or shared with anyone.

Your name Name*

First NameLast Name

Email*

example@example.com

City*

State*

Country*

Best telephone number to reach you*

Area CodePhone Number

Cell phoneLandlineWhatsApp

Pet's Name*

Dog or cat*

Breed*

Age*

MaleFemale

Current weight*

PerfectOverweightUnderweightOther

YesNo

If yes, at what age?*

Where did you get your pet?*

How old was he/she?*

What issues are you currently experiencing? Please be as detailed as you can. The more I know the better I can help you.*

When did this start?*

Please list all current medications (prescriptions)*

Please list all current supplements, including dosages*

What type of food has he/she been on for most of his/her life?*

What are you feeding now?*

Please list any other health problems from the past until now*

If any problems also list when they occurred and how you treated them

Please tell me about your vaccine history. I am not judging you for any choices you make regarding vaccination, but it's important that I know the history.*

If you can please list types given and time.

Did your pet have any reactions to the vaccines?*

When was the last vaccine done?*

Please upload one or more images of your pet. If you have an issue that is visible (such as a tumor), please provide a photo of it.

Browse Files

Please upload any medical records, like blood work and X-rays.

Browse Files

Is there anything else you would like to add? Please add anything you can think of that may have contributed to the issue (s) *

Disclaimer:

Thomas Sandberg, a board-certified animal naturopath, is not to be held responsible for any advice or information he shares. The content provided by Thomas Sandberg is intended for informational purposes only, and it is entirely up to you whether or not you choose to follow his advice.

Please note that as a naturopath, Thomas Sandberg does NOT examine, diagnose, treat, or offer to treat or cure any medical or mental diseases, disorders, illnesses, or any physical deformity or injury. Furthermore, Thomas Sandberg does not recommend or prescribe any changes to the dosage or discontinuation of any prescription medications or pharmaceutical drugs.

Always consult with a qualified healthcare professional or veterinarian before making any decisions regarding the health and well-being of your animals.

Please initial this to confirm that you read the above disclaimer *

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Thank you for taking the time to do this!

I am looking forward to helping you with your animal.

Thomas Sandberg

Health History Form