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time you require is not available, or you prefer a home visit consultation please

New Client Intake Form

Please answer what you can. This helps me begin understanding your pet holistically. We’ll explore more during your consultation.

Your Details

Full Name:

Email:

Phone Number:

Address:

How did you hear about me?

Animal Details

Animal’s Name:

Species & Breed:

Age / DOB:

Sex & Desexing Info:

Weight:

How long have you had them? Where from?

1. Current Concern

What is the main issue?

When did it begin? Progression?

What helps or worsens it?

Previous treatments & responses:

2. Medical & Health History

Past illnesses, injuries, surgeries:

Reactions to medications or vaccines?

Vaccination status:

Current meds, supplements, or natural treatments:

3. Diet & Lifestyle

Diet (brand/type/frequency):

Supplements, treats, table food:

Water source:

Living situation & environment:

Activity level / daily routine:

4. Physical & Emotional State

General personality / temperament:

Fears, anxieties, sensitivities:

Changes in appetite, thirst, energy, sleep, etc.:

Unusual behaviors or habits:

Changes before this issue began?

5. Your Observations & Goals

What do you think caused this issue?

What’s changed most since it began?

What do you hope to achieve through this consultation?

Anything else I should know?