Why are you seeking acupuncture services for your pet?
What are you hoping acupuncture will do for your pet?
What is your pet's current specific medical problem?
Please list all major health problems that your pet has had in the past.
List any treatments being used to treat the current medical problem. Be sure to include any conventional (e.g.. surgeries, antibiotics, steroids) or holistic therapies (e.g. chiropractic, herbs, supplements).
How is your pet's elimination? Particular smell? Dry or loose stools? Urinary incontinence?
Please list your pet's vaccine schedule, including the frequency of vaccination (e.g. every year, every 3 years)
What specifically does your pet eat (e.g. home-prepared, raw, kibble, canned)? How often? What is the quantity of food fed at each meal?
What kind of treats does your animal eat (include everything)?
Does your pet have any kind of dietary sensitivities or food allergies?
Does your pet have any unusual cravings (e.g. grass, dirt, rocks, feces, plastic, metal)?
How is your pet's level of thirst? Have there been any recent changes?
Have there been any major changes in the pet's household environment (e.g. moving, marriage, death of another pet or human, divorce, new pet, new children)?
How would your describe the household environment for your pet (e.g. calm, stressful, chaotic, mellow, lonely, crowded)
Describe your pet's sleep habits. Where does (s)he sleep? Does (s)he move from place to place during the night?
Describe your pet's activity level. Does (s)he tire easily? Never seems to tire?
Describe a typical daily schedule for your pet.
Please list all the people and animals currently living in the household.
Does anyone in the household receive holistic medical treatments (e.g. acupuncture, chiropractic care, massage, supplements)? If yes, please describe further.