Pet Health & Wellness Assessment Form
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Pet Health & Wellness Assessment Form


"I am ready to tell you everything I know about my pet's health, behaviour and/or emotional issues, including any vet diagnosis, lab test results, diet, lifestyle and my own observations, so you can give us the best and most relevant help we need."

This is the form you need to fill out whether you want a QUICK Holistic Pet Assessment, Holistic Pet Wellness Consultation or Distant Pet Healing Therapies.


Please complete 1 assessment form per pet unless all your pets are having identical symptoms (e.g. chickens, puppies, kittens, herds).

The more relevant observation and information you can give us the better. Please stay calm while you fill out this form to ensure we can understand your information and to avoid delay.

Once completed and submitted, we will process the form based on our own urgency assessment and date of submission. If your email address is invalid or mis-spelled, this form will not be reviewed but deleted after a 30-day hold.

We will contact you by email once we finish reviewing your pet's case. We respond thoroughly to everyone, please be patient.

Please take your time to fill out the Pet Health & Wellness Assessment Form now...


1. Firstname:

2. Lastname:

3. Email:

Must be valid (correct spelling). Must match newsletter subscription or order email address. Check your email for follow-up questions & response.

Pet Condition Urgency

Please note we're closed weekends & holidays. See office hours exception.

4. Phone Number (optional):

Include area code (Canada & US only).

5. Animal Species:

If inquiring about multiple animals, please check all that applies.

6. General Pet Info:

(a) Your pet's name, gender, specie, age, weight, breed. For multiple pets, use the "names" to indicate variation of symptoms for each pet in subsequent boxes (e.g. all pets have flu but different severity of symptoms).

Your Own Observation of Current Symptoms & Recent Ailments

(b) Enter as much details as you can - e.g. discharges (eye, ear, nose, mouth, penis, vagina), stool & urine (frequency, quantity, color, texture, smell, contents, difficulty, unusual pattern); mouth (teeth, gum, tongue, breath); skin, hair & nails condition; breathing (sound); mobility, structural problem; behaviour, mood; situation when symptoms are worse or better; etc., include MM/YY if you can. Do not enter disease labels or vet diagnosis here.

Diagnosis & Treatment of Current Symptoms & Recent Ailments

(c) Describe vet exam & diagnosis, disease labels, test results, surgery, vet treatment, holistic therapy and any pet psychic report for current symptoms and recent ailments. If treated with vet drugs medication, supplements, homeopathy, herbs - describe brand, manufacturer, ingredients (or a web link to them), potencies, effectiveness, side effects (if any) & MM/YY.

Other Symptoms & Health Issues

(d) Big & small, related & unrelated to your current concerns. E.g. teeth tartar, smelly coat, skin problems, chronic diarrhea, sneezing, tumors, ear discharge, etc.

Vaccination, Surgery, Drugs & Trauma History

(e) Full history if possible - past, general and/or non-related treatments, include MM/YY. E.g. Treatment for fleas, pests or worms. Surgeries for spay/neuter/teeth cleaning. Other illnesses & treatments. Accident, past abuse or events that were stressful, fearful or unhappy for your pet.

Natural Supplements, Remedies & Therapy History

(f) Recent use of supplements, herbs, holistic remedies or therapy - their effectiveness, side effects if any - for general or non related ailments. Enter the brand, manufacturer & ingredients if relevant.

Current and Past Diet

(g) Very important - type in the correct pet food brand & manufacturer, and enter either the pet food ingredients (omit synthetic vitamin/mineral list) or a web link to the ingredients.

Exercise, Play & Affection

(h) Type and amount of exercise, mental stimulation, fun playtime, fresh air, sunshine (aka Vit D) and affection your pet gets.

Emotions & Behaviour

(i) Pet's behaviour, emotional mood - indicate normal and unusual. Trace back to the start and describe possible trigger if you can.

External Factors

(j) Outside factors - other pets, people, environmental factors or family situation that may cause stress.

Other

(k) Anything else that you want to add.
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Forced Disclaimer: Information on this website, marketing materials and all communication are for educational purposes only. Statements on this website have not been evaluated by the FDA or Health Canada. The products are not intended to diagnose, treat, cure nor prevent any disease(s). We are not veterinarians. You understand you use non-veterinarian prescribed product, therapy, treatment, including ours, at your own risk. Always consult a veterinarian for your pet's health problem and condition.

Our Warning: Pharmaceutical medication and veterinary medicine can cause serious side effects, damage to your pet's health, even death. Use with caution. Always do your own homework, consult your own intelligence & intuition for your pet's disorder.