Holistic Veterinary Consultation Intake Form

Animal's Name

Does your animal live indoors/outdoors or both?

Length of time in your care?

Are you the first and only owner?

Do you have any significant information about your animal's life before you adopted him/her?

Primary Health Concerns

What are your main concerns for your pet at this time?

When did these symptoms first appear?

Has your animal received a formal diagnosis? If yes, please specify.

Did the start of the symptoms coincide with any major stressors, either in your animals or your life? Eg. moving house, losing a loved one, addition of new family members or pets, rehoming etc? Please explain below.

Physical Symptoms

Please discuss relevant details of any of the above symptoms:

Veterinary History

Has your pet been examined by your regular veterinarian in the past 6 months?

Yes

No

If the answer to the above question was no, when was the last time your pet underwent a physical examination or received veterinary care?

Current medications (name, dose, duration)

Is your pet up to date with vaccinations?

Yes

No

When was the last vaccination given?

Day

Month

Year

Does your pet recieve chemical intestinal or heartworm medication?

Yes

No

When was the last dose given, and what brand do you use?

Does your pet receive chemical flea or tick treatment?

Yes

No

If yes, what brand do you use?

Recent blood work or diagnostics?

Yes

No

If yes, are you able to upload reports? (ignore if full medical history has been uploaded or you have consented to Dr Cass requesting it from your veterinarian).

Past medications or treatments

Supplements currently used

Previous surgeries or procedures (desexing, dental, imaging, other)

Diet and Nutrition

Current diet (brand/type/raw/home-cooked/frequency/)

How long has your animal been. on this diet?

What type of treats are given and how often?

Any known food sensitivities or allergies?

Water source (tap/filtered/spring/etc.)?

Does your pet eat bones?

Does your pet eat things off the ground or hunt/scavenge? Please describe below:

Do you feel your pet is:

Overweight

Underweight

Healthy weight

Are there any diets you would like to try for your pet?

Do. you have any specific concerns or questions regarding diet for your pet?

Environment & Lifestyle

Living environment (house/apartment/rural/etc.)

Other animals in the home

Major changes or stressors in the last 12 months

Is there any exposure to chemicals, toxins, radiation, EMF?

How much exercise dow your pet get daily?

What does your pet's typical day involve? Do they spend a lot of time alone?

Emotional & Behavioural Observations

(This helps me understand the whole being, not just symptoms)

How would you describe your animal's temperament or personality?

Any changes in behaviour recently?

How does your animal respond to stress?

Is your animal affectionate? How do they react to strangers, children, other animals, car rides, vet visits?

Guardian Intuition

What do you feel is going on with your cat beneath the surface?

Is there anything you feel is important that hasn’t been asked?

Support & Commitment

Are you open to an integrative approach alongside conventional veterinary care, and consent to complimentary and alternative medicine (CAM)?

Yes

No

Consent

I understand this service provides holistic & educational support and does not replace in‑person veterinary diagnosis or emergency care.

Thank you

Thank you for completing this intake form. Your responses allow me to create a truly personalised, compassionate support plan for your animal.

You will receive next steps via email after your form is reviewed.