Your Name: * Address: E-mail address: * Contact phone number: * Pet Name: Animal species: Select value cat dog horse bird reptile other Breed: Age: Sex: Desexed: Weight: How regularly has your pet been vaccinated?: Select value Not at all Only when young As least often as possible 2 yearly Annually Main reason for consultation: Please list all of the physical symptoms that your pet has. I have listed body systems below to jog your memory, please note anything you think may be out of the ordinary.
PHYSICAL SYMPTOMS
custom_14 1. FUR / SKIN / NAILS – please note location of any redness, growths, hot spots, blisters, bleeding, greasy fur, bad smell, warts, tumours, discolouration and the specific areas your pet may scratch or gnaw at.: 2. MOUTH / TEETH / GUMS – note any excessive drooling, bad breath, loose teeth, inflammation etc: 3. Eyes / Ears / Nose – is there any discharge, what colour and consistency; any inflammation, recurring infections? Describe in detail: 4. THROAT / OESOPHAGUS / RESPIRATORY – cough, choking, bringing up food. Any problems breathing, noisy breathing, gets out of breath easily upon exertion, snoring etc: 5. DIET AND DIGESTION – please write down what your animal’s normal diet and any “human” food that is given from time to time, and any favourite foods plus foods it will not eat. Note any belching, car sickness, vomiting, excessive wind, diarrhoea etc. Does your pet try to eat inedible things e.g. dirt, animal poo? Is your pet a fussy or greedy eater? 6. Please list any dietary supplements, vitamins, or medications your pet is taking on a regular basis: 7. KIDNEYS AND URINATION – note any problems relating to urinating – difficult, excessive. Any vet diagnosis of kidney disease/stones. Does your pet drink a lot of or very little water?: 8. HEART AND CIRCULATION – any dysrhythmia, diagnosed heart condition; Note your pet’s reaction to hot, cold, or wet weather i.e. shivering, lies right by the fire, stays in shadows when out walking in hot weather: 9. JOINTS, MUSCLES AND BONES – any hip dysplasia, prior injuries, arthritis, trouble walking, getting up or lying down, jumping into the car, favouring a paw, stiff spine or neck: 10. Where does your pet normally sleep? : 11. Think back to when the problem first started – was there a change of house, new baby or another animal becoming part of the household? 12. Activity Level – does your pet tire easily, or could run or play for ages: BEHAVIOURAL SYMPTOMS
custom_27 13. Describe your pet’s temperament and personality (tick all that apply): 14. Is your pet easy to train? Stubborn? Not particularly bright? What is their favourite game? 15. How does your pet get on with other animals? 16. How does your pet get on with humans – i.e. family, children, strangers? 17. What fears does your pet have?: e.g. strangers, loud noises, thunder storms, fireworks, other animals, water etc. Does it react in an aggressive way – barking, biting; or fearful – runs away, hides: 18. Does your pet suffer from separation anxiety? i.e. possessive/protective, clingy behaviour, destructive when left alone: 19. Hierachy: Is your pet at the ‘top of the food chain’ or submissive, territorial? Please describe: 20. Please describe any other behavioural symptoms that you can think of:: Please feel free to write anything else that you think may be relevant to your pet’s case: Please attach a relevant photo (maximum size 2Mb): Please attach another relevant photo (maximum size 2Mb): I may contact you by phone or email within the next couple of days to clarify the information.
custom_38 Please select your Payment Type: I will email a Paypal invoice to you or you may direct deposit the amount to my account.
custom_40 Word Verification: type_submit_reset_44 Submit Reset
