Animal Intake Form

THIS FORM IS NOT FOR HORSES!  Click here for an Equine Intake Form

For cats, dog and all other species, except equines, please fill out the form below:

Please fill out and submit this form at least 48 hours prior to your initial appointment. Required fields are marked with a red asterisk. The information you provide is held as private and will not be shared without your expressed permission.
  • Description

  • Common name is fine.
  • Acquisition

  • Lifestyle and Management

  • Please be specific: wet or dry, brand name with flavors.
  • Please give brand names.
  • Please list vaccinations and include frequency of shots.
  • Does you have a regular exersize program for your animal? If so, please explain.
  • Medical History

    Include anything historic and significant that has occurred while you have cared for this animal and prior to your aquisition, if known.
  • Emotional or mental health issues or impact from traumatic experience.
  • Current Condition

    Any health issues this animal has presently.
  • Physical illness or injuries.
  • Emotional and mental health issues.
  • For reference only. I will not contact your veterinarian unless you specifically ask me to.
  • Please list any medications your animal is currently taking: dosage; start and end dates of meds; and why.
  • Healing Session Focus

    Please take the neccessary time to consider the following question.