Greenpet - Naturopathic Consultation

Your Details

Name

Address

E-Mail

Phone

Fax

Your Pet's Details

Pet's Name

Species

Breed

Color

M/F

Age/DOB

Weight

Desexed

Vaccinated

Current Health Condition

Please detail current condition in as much detail as possible including veterinary diagnosis if available:

How long has he/she had the above complaint?

Is the condition worse or better at any particular times (night, humidity, cold, after exercise, after rest etc)?

Was there any change in circumstances that may relate to the condition (new baby or pet, change of address, new diet, etc)?

How long have you had him/her (since puppy, kitten, foal, animal shelter)?

Dietary History

Please give full details of all food that is fed to your pet, including brands if processed food. List any supplements given and how often he/she is fed, including snacks: List previous diet also, if changed in the last 12 months? Or any special diets you have previously tried & for how long?

Personality

Please detail animals personality & characteristics (Sociable, timid, fears specific things -thunder, fireworks, hyperactive, aggressive towards people or other dogs, jealous, overly protective, etc)

Health History
(Please be very specific)

COAT AND SKIN - Itchy, dry, dull, smelly, bald patches, shiny, flakey, red, inflammed, greasy, blackening, hot spots, pimples, warts, growths or tumours, etc. If he /she has a skin condition please describe the skin in as much detail as possible. Where exactly is the skin affected (base of tail, under belly, paws, legs, back, head & face, all over)? If he/she has any growths, please describe (hard, soft, fatty, cauliflower-like warts, etc)

Is there any discharge? If so, from where (ears, eyes or skin, etc)- yellow/green, sticky, stringy, clear mucous, brown, foul smelling, bloody, etc.

EARS--Smelly, itchy, discharge, dirty, wax, mites, frequent infections

EYES - Watery, discharge, tear stains, blocked tear ducts, are inner eyelids - pink, red or very pale?

MOUTH - Does he/she have bad breath, are gums pink, red or pale? Any signs of ulcers, growths or anything unusual?

DIGESTION- Does he/she suffer from diarrhoea, constipation (straining or infrequent bowel movements), flatulence, vomiting or any other digestive disturbance? Has weight changed recently?

URINATION/THIRST- Does he/she have free access to outside or use litter tray? Has normal water intake changed recently? Town water or rainwater? Is urine dark, bloody, smelly, painful or unusual in any way? Does he /she drink a lot or a take frequent small drinks, is urination painful or is he/she having difficulty voiding?

APPETITE - Poor appetite, ravenous, fussy eater, always hungry or eat unusual things, if so, what? Has appetite changed recently? Is he/she under or over weight? If pet is not eating, how long since last meal? Has he/she done this before?

TEETH/GUMS- Are teeth white, yellow or browning on gum line, are they chipped or worn down? Are gums red, sore, inflammed, swollen?

ALLERGIES - Does he/she have any allergies, if so -give details? Does he/she suffer from any of the following symptoms - chewing or licking front paws, chronic skin conditions, recurring ear or eye infections, excessive licking or chewing fur, chronic digestive problems, excessive emotional traits (aggressiveness or nervousness), chronic urinary problems, seizures, immune dysfunction, joint inflammation, etc.

JOINTS/ MUSCLES - Stiffness, swelling, pain, lethargy, limping, restless, is it worse after exercise or better for movement? Has there been any injuries prior to condition developing? Please describe:

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

Worming medication (Type and how often it is given)-

If vaccinated, is he/she up to date with all vaccines, are they given yearly or less frequently? When was last vaccine given? 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)

Flea or tick medication (List type used and frequency of use. Have you been happy with results of this so far? Has he/she ever had a paralysis tick or get fleas or other parasites?

Please list any other information you feel may be relevant

Thank you for taking the time to complete this form. You may also send a photo, but this is not essential. Send photo to info@greenpet.com.au

We will contact you on completion of the consultation. Generally within 24- 48 hours.

How would you prefer to pay for this consultation?

We accept the following Credit cards (Bankcard, MasterCard & Visa only), Cheques, Money orders, or you may pay by Direct Deposit to a Westpac bank.

Details will be forwarded to you by email and post on completion, ONLY once payment is received.

Is your dog itchy?

'Woody' before natural treatment
for mange

'Woody' 1 month after treatment

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