Homeopathic Consultation Intake Form

(To be completed in addition to the general intake form)

This form focuses on the whole being, not just the diagnosis. Please answer as fully and honestly as possible.

About this form

Homeopathy looks at the whole individual, not just a diagnosis. The questions below help me understand your animal’s physical health, emotional state, behaviour, and life history so I can select the most appropriate remedy. There are no right or wrong answers — please answer as honestly and in as much detail as you can. Even details that seem unrelated may be important.

Client's Full Name

Animal's Name

General Nature & Personality

Describe your pet’s personality in their best state

Use 5-10 key words or phrases to describe your pet:

Describe your pet when unwell

Are they confident, timid, clingy, independent, dominant, sensitive?

How do they relate to people? Other animals?

Is there anything peculiar about your pet? Please describe below.

Your Relationship with your Animal

Describe the family dynamics (how many people and animals live in the home with your animal?/what is their relationship to them?)

How would you describe your bond with your animal?

Have you noticed emotional mirroring or shared stress patterns?

Emotional & Mental Symptoms

Does your animal have any fears (noise, storms, vet, separation, strangers, other animals)?

Anxiety or restlessness? If yes, please explain.

Aggression or irritability (when, towards whom)?

Does your pet show signs of depression, withdrawal or apathy? Would they ever bite someone? Would they bite another animal?

Have you noticed any changes in your pet after stress situations, trauma, illness, vaccination, or surgery? Please give details.

Physical Generals

Does your pet have a temperature preference (seeks warmth / seeks cool / worse heat / worse cold)?

Weather sensitivity (how does your pet feel about rain, storms, humidity, dry weather)?

Energy patterns - do you notice that the symptoms change throughout the day? (what time of day are they better or worse)?

Is your pet thirsty? (amount they drink?, do they have a preference for warm/cold water?)

Is their appetite strong/weak/ravenous/picky?

Food Preferences & Aversions

Do they have strong cravings for specific foods?

Strong dislikes or foods that aggravate symptoms?

Are they better or worse after eating? Or no noticeable difference?

Sleep & Rest

Where do they sleep? Sleeping positions?

Restless or settled sleeper?

Do you notice any dreams, vocalising, or twitching during sleep?

Are symptoms worse at night? If so, is it at a specific time?

Main Complaints (Homeopathic View)

For EACH main symptom, please describe:

Location (where exactly)
Do you think it is painful?
Onset (sudden/gradual)
Duration
What makes it better?
What makes it worse?
Time of day symptoms are worst

Symptom 1

Symptom 2

Symptom 3

Symptom 4

Symptom 5

Past Suppressions

Long-term use of steroids, antibiotics, antipruritics or other medications?

Has your animal had skin issues, ear issues, discharges, infections in the past treated with pharmaceuticals?

Reactions after medications or vaccines?

Vaccination & Parasite Control History

Reactions to vaccines (immediate or delayed)? Please describe below.

Reactions to any flea, tick or worming treatments? Please describe below.

Major Life Events Timeline

Early life history (breeder, rescue, trauma)?

Illnesses over the years?(List in chronological order if possible)

Emotional or physical shocks?

Did any life changes that coincided with symptom onset?

Overall Vitality

Would you say your pet is generally resilient or fragile?

How do they cope with stress?

Do they bounce back quickly from illness?

Anything else you feel is important?

Please list as much detail as you like:

Homeopathy Consent

I understand homeopathy works on the whole individual I understand symptoms may shift or change during treatment I agree to follow dosing and monitoring instructions

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