Consult Form – Catherine Edwards

Thank you for booking a Consult.

Before I can confirm your booking, please complete the following consultation form, in as much detail as you can, as soon as possible.

This allows me to prepare for our call and fully understand what you would like to get out of the session. Once I have received the completed form I will send through the Zoom link for your call.

Please note all zoom invites are in UK London time – please ensure you calculate the correct time of the call for your time zone – taking into account summer / winter time zones in both countries. I find using the iPhone World Clock the easiest way to work it out!

Please complete the following form – I will review and the booking request thank you.

Animal Consults
Root Cause Consults

Animal Consults

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*
How Did You Hear About Me?*
Please include any social media platforms , personal recommendations etc.
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*
- General Wellness Consult
- Animal Commiunication
- Distant Iridology
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
Dental Information
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

Root Cause Consults

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)
Your Name*
EMail*
Phone Number Including Country Code*
Address and Time Zone*
What are you current Health Challenges?*
Please describe, In as much detail as possible, your current health challenges IN ORDER OF PRIORITY.
What Impact do these challenges have on your daily life?*
Please describe, In as much detail as possible, how these issues affect your daily life. Please be specific. INCLUDE ANYTHING YOU CAN'T DO BECAUSE OF THIS, HOW THEY MAKE YOU FEEL
Please list any medications you are on & any medical treatment you are currently receiving or have received within the last year
Please provide full details and include which have been effective with descriptions
Please list any supplements or holistic alternative therapies you have tried within the last 5 years
Please provide full details and include which have been effective with descriptions
Possible Chemical Exposure*
Please provide full details of possible chemical exposure - including household cleaners used; any chemicals used in the garden; do you have agricultural land near where your live, any known mould exposure etc.
Exercise Details & Times*
Please provide full details of typical weekly exercise undertaken - please be honest
Diet & Supplements*
Please provide full details of your diet/supplements, if there have been any changes to this in recent months. e.g. vegetarian / vegan / carnivore. Do you drink / smoke / take recreational drugs?
Sleep Patterns*
Please describe in as much detail as possible how your sleep is, do you wake feeling rested and happy etc?
Any Known Allergies?*
Please describe any known allergies, how long thees have been present and what symptoms they show
Stress & Relaxation*
Please describe how you cope with stress, what current stress / relevant past stress you are experiencing. Anything you feel relevant. Please describe how you relax - include as much detail as possible
Dental Information
Have you had any significant dental treatment - of so please state when and details of what was undertaken.
Water Intake*
Please describe approximately how much water you drink on an average day, and if you have any filter / water treatment
Sign & Date*
Please sign / print name and date confirming all the information provided is correct

Animal Consults

Root Cause Consults

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