Complete Online Consultation Form
Please note we do not diagnose please see a vet for this.
Required answers are marked with *
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Name
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Street Address
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Address Line 2
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Suburb/City
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State
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Post/Zip Code
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Country
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Phone (incl area codes)
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Email
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Information About Your Pet
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Name of Pet
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Type of Animal
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Age
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Sex
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What Medications is Your
Pet Currently Taking?
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List Previous Sicknesses
/Diseases / Injuries
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List Current Diseases /
Symptoms and when
they first appeared
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How Thirsty is Your Pet?
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Is Your Pet’s Appetite :
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Weight - How Much
Does Your Pet Weigh?
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Bowel Movements - Does
your pet suffer from
diarrhea, constipation,
mucous in the blood or
stool, flatulence or bloating?
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Urine - Is the urine dark
yellow, cloudy, frequent,
irregular, bloody?
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Is Your Pet :
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How would you describe
your pet - aggressive,
fearful, neurotic, happy,
anxious ?
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Does your pet have any
rashes, discharge, itchy or
dry skin on their body?
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Head, Eyes, Ears, Throat,
Nose, Mouth - Are there
any symptoms with vision
or hearing etc ?
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Is your pet frequently
unwell, or very rarely ill?
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Sleeping - Does your pet
sleep deeply or lightly, or
does it dream frequently, or
have a fitful sleep ?
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Respiratory - Does your pet
suffer from a cough or
shortness of breath, with or
without mucous ?
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Skeletal/Muscle Problems
Does your pet have any :
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Click Control + C to select multiple answers
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Please describe :
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Does your pet sweat a lot?
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Does your pet have a
preference for :
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Please add any other
observations or comments
about your pet :
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