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*Please read the following DISCLAIMER before filling out your pet's profile.
Please complete each section in order to best assess what program we can recommend to you. All information will be maintained as strictly confidential. Please ensure that all marked areas are filled out before submitting. Personal Profile
Name of Animal: *Name of Owners: *Address 1: Address 2: *City: *Province/State: *Country: *Postal/Zip Code: *Telephone 1: Telephone 2: Fax: *E-mail: Use: Housing: Species: Breed: Date Of Birth: Referring Veterinarian: Date of Last Visit: Reason For Visit:		Please list any other conditions: Has your pet been treated with chronic antibiotic therapy? Please list all current pharmaceutical drugs:   Please list all current vitamins, herbs, or food supplements: Areas of Concern Comments and areas of concern:   Lifestyle Considerations: Does your pet get regular exercise?
Instructions: Answer the statements below by checking the line which applies to the animal. Pet Health Profile
Experiencing exercise intolerance Congestion in sinuses and lungs, allergies, heaves Breath polluted air, smoking household Constipation and or hard stools, flatulence Digestive problems Kidney/Bladder problems Heart/Circulation problems	Reproductive problems Lameness Over weight/Under weight Pregnant Skin disorders, Fungus, Bacteria, Allergies Foul Breath Eye problem discharge/red Ear brown discharge/yeast infections Nail health/chipping
We appreciate the opportunity to discuss your problems and concerns. We wish to make it clear that our intent is not to diagnose or prescribe, but to offer recommendations and information to help you establish a healthy order in your animal's daily life. If you seek medical advice, please consult a veterinarian. If you are seeking ways to take responsibility for your animal's health and well being, we are happy to be of assistance.

       

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