Alex Melo ANIMAL QUESTIONNAIRE

DETAILS Owner’s Name: Date: Owner’s Phone: Owner’s Email: Owner’s Skype Name: Pet’s Name: Sex: Breed: Age: PLEASE ANSWER THE APPROPRIATE QUESTIONS REGARDING THE TYPE OF ANIMAL. REMEMBER TRY TO BE AS THROUGH AND DETAILED AS POSSIBLE AS THE CORRECT INFORMATION WILL LEAD TO THE CORRECT PRESCRIPTION. Diet: (foods given, please mention everything including supplements and snacks)

Vaccinations given and when (any after affects?):

Is this animal from a breeder?

Do you know the medical history of the parents?

Illnesses in the animal’s history: (Please include medications if any)

Description of physical characteristics:

When did the animal come to you and the circumstances surrounding it?

Are there other animals in the house?

How does the animal get along with the other animals?

Also, how is the animal with new animals in new situations? (Reserved, friendly, hostile, etc)

Other people in family? (Please name, age, gender)

How does the animal get along with the members of the family? Please give the dynamics.

Is he close to you, wants to follow you around everywhere?

Is the animal affectionate? How?

Does he like company or does he tend to be off by himself?

How is the animal with people that are strangers?

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How does he react to a new person coming into the house?

To you or a family member entering the house?

How is he with children?

Does the animal like to ride in the car? How does the animal act? When the animal sees animals or people outside the car?

Generally speaking, is he protective? Scared? Aggressive?

Is he sensitive to being scolded?

Does he like to eat all the time? What are his food preferences and dislikes? Is he picky? Does he only like warm food? Cold? Room temp?

Is he fed certain times of the day? Do you find he wants food at certain times of the day between meals?

Does he tend to gain weight or is he as nervous as a “race horse”

Is he messy in his eating habits? Or does he clean out his bowl to the last particle?

Does he vomit or have diarrhea or flatulence, etc. following eating?

Is he thirsty a lot of the time? How much water would you think he drinks in a day? What temperature of the water do you think your animal prefers?

Does your animal have bad breath?

Are his teeth clean?

Is there a red line above the teeth on the gum?

Any redness in the gums?

Has he ever had gum or teeth problems? Been treated for it? What was the treatment?

What do you do to keep your animal’s teeth healthy?

Does your animal ever get parasite medication? (fleas, heartworm, tape, round, etc.)

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Does he like to walk or a couch potato?

Lay in the sun? or someplace warm? Does he look for fresh air or cool places? Does he lay under the heater or under the fan?

Does he jump up early in the morning for his morning walk or do you have to drag him out the door?

Does he sleep through the night?

Is his pillow, someone’s leg, the couch, his best friend?

How is his stool? Is it well formed? Dark in color? Or light in color? Or have yellow in it? How often does he pass stool?

How is the urine? Is it a color? Describe the amount. How often does he urinate?

Has there been a change in behavior or physical habits?

Are there any discharges from the animal? Where, how much, and what color and consistency? (please include ears in this topic)

Does your animal show anger or hurt if you’ve been away for a long time? How?

What is the animal’s home environment? (alone, companions, restrictions, bedding, etc)

What do you use to clean your home with? Wash the bedding with?

Where does your animal like to sleep?

In what position does your animal lie down? Does he favor one side or the other?

What other characteristics about your animal can you think of that have not been mentioned above?

PLEASE DESCRIBE YOUR ANIMAL BY ANSWERING YES OR NO AFRAID OF: Thunderstorms:

Strangers:

Something new in the environment:

Loud noises:

Startle easily:

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An object (please describe):

Quick movement:

IS YOUR ANIMAL: Willful Dominant Submissive Shy Noisy Quiet Excitable Docile Impulsive Steady Careful Clumsy Gentle Rough Obedient Disobedient Remorseful Defiant Sweet Masculine Feminine What is your animal’s health problem? When did it begin?

What happened in the animal’s life around this time?

What aggravates the problem? (foods, weather, noise, heat/cold, etc.)

When during the day is the problem worst?

Any past or present skin problems or skin lesions?

What are your expectations about your pet being treated homeopathically?

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