Earth Horse Healing

Ginger Krantz - Healer, Teacher, Mentor

Small Animal Intake Form

Animal Intake

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.

"*" indicates required fields

Name of Owner*
Address*
Session Format*
Appointment Scheduling*
Please choose all times you are available in Eastern Time, thank you.

Description

Common name is fine.
Sex*
The Age Specified Is:*

Acquisition

Lifestyle and Management

Medical History

Include anything significant that has occurred while you have cared for this animal and prior to your acquisition, if known.

Current Condition

Any health issues this animal has presently.
Physical illness or injuries.
Has your pet ever bitten anyone? Has it ever displayed any aggressive behavior?*
Is your pet comfortable being touched all over its body?*
For reference only. I will not contact your veterinarian unless you specifically ask me to.

Healing Session Focus

Please take the neccessary time to consider the following question.
Would you like be added to my email list?*
To receive occasional emails about events and class announcements.