Phone: 07 5449 1453

Clinic Hours: 9am-4.00pm (Qld time) Mon-Fri
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  Emotional Issues
  NATUROPATHIC CONSULTATION FORM -
FOR EMOTIONAL ISSUES
If your pet is suffering from an emotional or behavioural problem, then a natural remedy can be made up to suit. The cost for this service is AUD $55.00 which includes a herbal, homeopathic or flower essence remedy. Remedies are selected depending on the animal needs. We use either Bach or Australian bush flower essences, homeopathy, herbal or homeobotanical remedies which can be safely given to all animals including cats, dogs, horses, rabbits, puppies and kittens.
  Your Details
Name 
Address 
E-Mail 
Phone 
Fax 
   
  Your Pet's Details
Pet's Name 
Species 
Breed 
Color 
M/F 
Age/DOB 
Weight 
De-sexed
Vaccinated
   
 
Personality

Please detail the animals personality & temperament.
 

Behaviour

  Please detail animals current behaviour or anything that appears unusual?  
   
  Training

Please detail training methods used?
   
  Diet 
  Please list all food fed and include supplements if used.  
 
 

 

  Previous History 
 

Has he / she suffered any emotional or physical abuse or traumas in the past?    

   
  How long has this condition or behaviour been going on for?
 
   
  Is the condition worse at any particular times?
 
   
  How long have you had him/her? Did he/ she come from a breeder, animal shelter or where?
 
   
  How does he/she react towards other people or animals?
   
 
   
  Did anything happen prior to the onset of the condition or behaviour eg. stay at kennels, loss in the family, moved house, etc?
   
 
   
  Please tick any of the following that help to describe him/her
   
  Fear of unknown things
  Fear of specific things
  Wary of strangers
  Intolerant
  Submissive (cowers down when approached)
  Lacking confidence
  Seeks approval or needs reassurance
  Compulsive or uncontrollable behaviour
  Inability to learn by experience
  Possessiveness or jealousy
  Attention seeking
  Hates being left alone
  Anger or agressiveness
  Grieving loss of loved one
  Hyperactive
  Nervous or timid
  Impatient
  Snappy or irritable
  Overly protective
  Highly-strung
  Erratic behaviour
  Overly affectionate
  Dominant, bossy or the leader of the pack
  Loner, likes to be left alone
  Unfriendly
  Depressed, lack of spark
   
  Please list any medication he/she is currently or previously taken over the last 12 months. If you cannot remember the name, then what was it given for & for how long? 
 
   
  ENVIRONMENT - Have you recently moved, sprayed for weeds or pests, installed anything new in house or yard, painted the house or put new plants in garden? Does he/she live inside, in a cage or run, stable, kennel, etc
 
   
  Medication -(Include worming, flea & tick drugs, etc)-
 
   
  If vaccinated, did you notice any symptoms occurring within days or weeks of any vaccination, if so, please detail (loss of appetite, lethargy, vomiting, seizures, stiff joints, etc)
 
 
  Please list any other information you feel may be relevant
 
 

Thank you for taking the time to complete this form.
I would prefer to pay by (see list below)
We accept the following Credit cards (Bankcard, MasterCard & Visa only), Cheques, Money orders, or you may pay by Direct Deposit to Westpac bank.

The remedy will be sent out to you on receipt of payment thank you.
IMPORTANT - Please select the payment option once submitting this form so we can process your consultation.
   
 
 
 
 
 

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Copyright © 2010 GREENPET, All Rights Reserved. The products and information given on these pages is not intended to substitute veterinary diagnosis and treatment, but to compliment it. If symptoms persist, please seek the advice of a qualified practitioner.

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