Please fill out this form and email it to Lu prior to your initial session.  Provide as much detailed information as possible about your animal and your primary concern(s).  Please include everything that comes to mind, even if it seems to be unrelated.

Disclaimer: Any advice given in response to information provided on this form is strictly for educational purposes and is not designed to be a substitute for veterinary care.

Animal’s Name:                                                  Breed:                                Age:             Sex:

Main issue/concern(s):

How long has this been going on?

Is it seasonal? Or worse at certain times of the day?

Please note any discharges, smells, inflammation, painful areas, etc:

Other Observations:

General Background:

Current Daily Routine:

Exercise/Discipline:

Herd Status:

Elimination Habits (recent changes in bowels/urination?):

Feeding Program(current diet/recent changes?):

Current Supplements:

Injuries (recent/past/current discomfort):

Environmental changes (loss of buddy, new neighbor, etc.):

Medical Procedures (recent & past, type & date):

Current Medications/Vaccinations:

Drug/Supplement Reactions:

Any Additional Comments: