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Lowcountry Vets at Old Town
Lowcountry Vets at May River
Lowcountry Vets at Ridgeland
Lowcountry Vets at Argent and Healing Holistic Care
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Contact Us
Initial Holistic Veterinary Treatment Information
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URL
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Client Information
Owner:
*
First*
Last*
Address:
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Street*
City*
State*
Zip Code*
Contact:
Cell
*
Home
Work
Email Address
*
Pet Information
Pet's Name
Breed
Color
Sex
Male
Female
Age
Spayed/Neutered?
Yes
No
Allergic Reactions
Yes
No
Medical History
Please list any and all current or previous medical conditions and treatments (seizures, heart murmur, asthma, surgeries, cancer etc.)
Please list ALL medications, supplements, vitamins, food toppers, and/or nutraceuticals you give to your pet
Primary care or referring veterinarian or hospital (if you are not a Lowcountry Vets client)
Treatment Plan for Your Pet’s Health
Briefly, what is your reason(s) for this visit and what are your goals for treatment?
Which treatment plans/modalities would you be interested in if suitable for your pet's condition(s)? Check all that apply. If you are not sure, we can explain our services on the day of your appointment.
Acupuncture
Traditional Chinese Herbal Medicine
Therapeutic Laser Therapy
Food Therapy and Homemade Recipes
Nutraceuticals or Supplements
Tuina (Massage and Acupressure)
Environment: What is home environment like? (from a shelter, lives with other pets?)
Diet:
How would you describe your pet's personality?
Outgoing
Shy
Aggressive
Content
Restless/anxious
Crabby
Depressed
Fearful
Aloof/indifferent
Temperature/bedding preference:
Hard Floors
Soft Bedding
Warm
Cool
Appetite:
Decreased
Same
Increased
Thirst:
Decreased
Same
Increased
Exercise:
None
Low
Moderate
High
Athlete
Stool:
Normal
Dry
Soft
Watery Diarrhea
Blood And/Or Foul-Smelling
Urine:
Dark/Scant
Normal Yellow
Bloody Or Smelly
Light Yellow/Clear
Seizures/other neurological issues?
Heart or breathing problems?
Lameness or pain?
Emotional/behavioral problems?
Dreaming or difficulty sleeping?
SMS Consent
I agree to receive recurring automated messages about pet care, appointment reminders, marketing communications, and offers to the mobile number provided. Your consent is not required, and you may opt out at any time by replying STOP. Msg & data rates may apply. Message frequency may vary.
I agree to receive SMS communications.
Email Consent
I agree to receive marketing offers and updates via your preferred/primary email. You'll still receive services and account related emails if you do not check the box.
I agree to receive email communications.
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