I’m supposed to piddle where?


Please provide the following background information for a consult if known:

Person(s) Name(s)

Mailing Address

Main Phone Number and Alternate Phone Number


Your relationship with the animal

Did someone refer you?

Animal’s Name


Sex and if neutered/spayed/gelded



Family Members (people and animals)

How did your animal come to be with you?

How long has your animal been with you?

Previous history before your animal came to you, if known.

Has your animal seen a veterinarian for any reason? Please explain.

What is the prime reason for your consultation?

What are your specific questions for your animal?

What would you like your animal to know?

What is the most important result or information you want from the session?



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