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Smart Bowen Animal Consultation Request

Please Note: This consultation is not a diagnosis of your animals problems, for a professional diagnosis you will need to consult with your veterinarian.

Consultations are processed in order of receipt, please allow several days up to a week for this to occur, due to other commitments that may see Lea Smart away from her office/clinic.

The initial consultation fee includes the supply of any homeopathic remedies, flower essences and delivery within Australia. Overseas consultations, remedies and delivery will be reflective of the exchange rate.

Subsequent consultations for the same animal related to the original consultation will be charged at a reduced fee. Remedies and delivery will remain the same.

Details of the consultation will be forwarded to you via email and the remedy/s via post, only after payment has been received. Payment may be made via direct debit, credit card, cheque, money order or pay pal,The office will contact you via email when the account has been finalized to arrange payment and delivery.

Should the client wish to contact Lea via phone, this can be arranged via email for a suitable date and time, at the client’s expense.

Please be patient and take the time to fill out the form with as much detail as you can provide. Remember, that if you and I were in a consultation room together with your animal or at your location, I would be asking ALL these questions. Your animal’s health and wellbeing are very important to me as a therapist and I will endeavour to provide the very best of care – to do so, I need your help and assistance with the questionnaire below. Forwarding a photo of your animal (if you have one) can be very beneficial.

Owners Details

Name:
Address: Home
Address: Delivery
Email:
Phone (include area code)
Fax:

Animals Details

Name:
Age/DOB:
Species:
Breed:
Colour:
Weight:
Sex:
Desexed:
Pregnant:
Vaccinated:

Reason For The Consultation

Please provide in detail all relevant information (past and present) inclusive of a veterinary diagnosis if available:

How long has this complaint been apparent?

How long have you had this animal in your care and if not bred by you, where did the animal come from?

Did any changes or situations occur that could be related to the condition (change of home, new animals into the home, arrival of a baby, change of diet, after medication, accident or trauma etc)?

Are there any particular times (morning, afternoon, night, after food, exercise, at rest, in the car, humidity, sun, rain or storms etc), that make this condition worse or better?

Personality/Temperament

Please provide in detail all relevant information relating to this animals personality, temperament, behavioural characteristics and social interactions with people (yourself inclusive) and other animals (timid, shy, bold, stoic, jealous, aggressive, protective, amiable, terrified of trucks, loud noises, thunder and lightning or water, loves games, walking, swimming or fixated on something, separation anxiety etc)? What makes this/these conditions better or worse?

General Health History

Please provide in detail all relevant information and with discharges, be very specific about where, what colour, smell, consistency, better/worse etc., that occurs with the discharge.

SKIN, COAT - any growths, tumors, warts, spots, allergies, hair loss, coat condition, smell, discharges, inflammation/irritation, parasites, itchy, licking etc.

DIGESTION – What do you feed and the quality of the food, colourings, preservatives, dry, wet, organic etc., Is there vomiting, burping, gut noises, flatulence, appetite, pain, allergies, malabsorption, unusual dietary habits, weight loss or gain etc.

DEFECATION - diarrhoea, constipation, straining, discharges, colour, parasites, anal glands etc.

THIRST/URINATION - water intake, water provision, kidney function, colour, consistency, discharges, straining, smell, frequency, incontinence, litter tray or natural ground etc.

REPRODUCTION - sterile, uterine infection/discharge, false pregnancy, over/under sexed, conception or pregnancy problems, abortion, penile/testicular dysfunction/problems/discharges etc

MOUTH/BREATH/DENTAL - smell, saliva, chewing or swallowing problems, rotten teeth, gum disease, gum colour, licking etc.

EYES - blind, cataracts and other eyesight or function problems, , growths, eye infections, allergies, tear ducts, eyelashes etc.

EARS - infections, discharges, parasites, itchy, dirty, wax, allergies, head shaking, deafness etc.

MIND - active, alert, sleepy, vague, forgetful, strokes, epilepsy, head injury etc

GENERAL BODY - fractures, deformities, amputations, gait compensations/stiffness, other diseases, arthritis, cancer, allergies, licking, pain and or crying out with pain movement etc.

MEDICATIONS – List any medications the animal is currently on taken in the past 12 months.

VACCINATIONS – List the last vaccination given and when (kennel cough, three in one, five in one, seven in one – what were these combinations?) How long has the animal been receiving vaccinations for? Any reactions after a vaccination?

WORMING – Has this animal been wormed, if so, when was the last worming (heartworm, intestinal worms) given and what was it for? How long has the animal been receiving worming? Any reactions after a worming?

FLEA/SKIN PARASITE – Has this animal been flea/skin parasite treated, if so, when and how long has the animal been receiving these treatments? Any reactions after a treatment?

ENVIRONMENT – Have you and or the animal changed the environment, sprayed for pests or weeds, changed floor coverings, furniture, bedding etc., in the house or yard, painted or polished flooring, walls etc., are there any toxic or noxious or irritant plants or weeds, does the animal sleep in a kennel/cattery/stable/cage is the bedding synthetic or natural? Does the animal where rugs or coats – how many and when? Does the animal live inside/outside or both. Do you live next door or near properties that spray chemicals? Does the animal swim and if so what kind of water?

TRAVEL – Does the animal suffer from any travel sickness, fears, phobias?

SPECIFIC HORSE INFORMATION – is the horse barefoot or shod, have feet problems, saddle related problems – what kind or work does this horse do?

FURTHER GENERAL INFORMATION – Please list any other relevant information that you believe will assist the consultation process.

THANK YOU for getting to the bottom of this form and having answered all these questions.
On occasions I have further questions or require more specifics on those you have offered, therefore I will be in touch via email where questions may be responded to, or I will set a time and date for you to call me.