Page 1 of 1
Traditional Chinese Veterinary Medicine (Acupuncture, Herbal, Food Therapy) - Sun Dog Cat Moon Veterinary Clinic
Owner Information
Name
*
Telephone
*
Email
*
Address
*
Animal Information
Name
*
Species
*
Sex
*
Age
*
Weight
*
Intact?
*
Intact?
A
Yes
B
No
Current Medications
Current Diet/Food
*
Main Concerns & Treatment Goals
*
Fire
Normals
*
Normals
Lively
Communicative
Very Friendly
Affectionate
Loves to be petted
Center of the party
None
Abnormals
*
Abnormals
Insomnia
Separation anxiety
Restless
Excess heat
Rapid heart rate
Heart problems
None
Wood
Normals
*
Normals
Decisive
Assertive
Confident
Strong
Impulsive
Athletic-Stamina
Alpha Animal
None
Abnormals
*
Abnormals
Ligament problems
Liver problems
Red eyes
Angers easily
Ear problems
Nail problems
Footpad problems
Anal sac issues
None
Earth
Normals
*
Normals
Relaxed, laid back
Sociable
Round and large
Loyal
Serene and balanced
Cares for others (motherly)
None
Abnormals
*
Abnormals
Diarrhea
Constipation
Loss of appetite
Vomits
Gum Disease
Weak Muscles
Overeats-obese
Worries
None
Water
Normals
*
Normals
Careful
Curious
Self contained
Likes to hide
Meditative
Slow and consistent
None
Abnormals
*
Abnormals
Rear weakness
Fearful
Bone and back issues
Urinary problems
Disturbed growth
Deafness
Reproductive problems
None
Metal
Normals
*
Normals
Loves order
Obeys the rules
Aloof
Symmetrical body
Disciplined attitude
Good hair/coat
None
Abnormals
*
Abnormals
Asthma
Dry skin
Sinus problems
Breathing disorder
Nose problems
Cough
None
Submit