Details of Consult Time / Date Booked (if Applicable) *
Please state what time and date you have booked for your consult (if you have already made a booking)
Name of Animal Parent *
Animal Parent Name
EMail * Phone Number Including Country Code * Address and Time Zone * Name, Sex & Age of Animal * Species & Breed (if Applicable) * Ho Long Has Your Animal Been In Your Care & Background? *
Please include anything known about their background before they came to you
Describe Physical & Behavioural Condition *
Please describe, in as much detail as possible and CURRENT or PREVIOUS physical or behavioural concerns
Decribe What You Hope To Get Out of Our Session *
Please describe, In as much detail as possible, what you hope to get out of our consult.
Please Tick which you would like included in your session *
Please select which of the following you would like included in your session - please note distant iridology is dependant on satisfactory pictures of each eye being sent and ill take the whole session, and for the Animal Communication please submit 2 pictures: 1 showing the face and 1 showing the whole animal
Veterinary or Other Diagnosis & Any Medication / Supplements / Therapies *
Please provide details of any diagnosis given to your animal. Please provide full details of any medication your animal is or has taken, any supplements, including brand names/ingredients and any treatments they have received
Any Therapies already Tried?
Please provide full details of any therapies that you have tried to address any current conditions - physical or behavioural
Paraiste Control & Vaccinations *
Please provide full details, including dates of known, of any treatments given for the control of fleas / ticks / worms or any other parasites etc and any vaccinations recieved
Possible Chemical Exposure *
Please provide full details of Household cleaners used (domestic animals); any chemicals used in garden/yard / fields; there you have agricultural land near where your animal is kept/exercised
Exercise Details & Times *
Please provide full details of typical weekly exercise undertaken - including opportunity to socialise with others from the same species
Feed & Supplements *
Please provide full details of feed/supplements / treats given regularly, if there have been any changes to this in recent months, and feeding times.
Changes in Behaviour *
Have there been any recent changes in behaviour recently? Please describe in as much detail as possible
Any Known Allergies? *
Please describe any known allergies, how long thees have been present and what symptoms they show
Eye or Nose Discharge, Skin & Coat Condition & Hoof Care Regime (Horses) *
Please describe if any eye or nose discharge, and describe condition of their coat/skin. For Horses please state if shod / any hoof issues / special balancing
Has your animal had a dental check/treatment - of so please state when and details of what was undertaken.
Neutered / Spayed / Gelded? *
Has your animal been spayed/neutered/gelded? If so when/ at what age? Any complications?
If female has your animal had any litters / foals - please provide full deatils including age weaned * Sign & Date *
Please sign / print name and date confirming all the information provided is correct