Cut and past to an email or document to mail or fax]

Owners Details
Name
Address
Phone (during business hours and after hours)
Mobile Number
Email
Owners Date of Birth
Who referred you to this service?

Animal’s Name
Pet or Stable Name
Location if different to above
Species
Breed
Age
Sex
Size (Hands if horse, and/or weight if dog)
Date of Birth if available

Veterinarian’s Name
Practice Address
Phone Number
Email (if known)
Do I have your permission to contact your veterinarian - YES or NO

What is your veterinarian’s diagnosis and prognosis? 
 
If no diagnosis, was there a reason for not obtaining one? 
What is the problem as you see it? 
How long have you had this animal? 
Does this animal live with you, or stabled or kennelled away from home? 
Does your animal live inside or outside the home, or stabled or paddocked, if this is both to what proportions? 
Is your animal rugged or blanketed? Does this vary with seasons or time of day? 
Are you the only handler of this animal, or are others feeding, grooming, riding, working, training? 
Discuss what this animal’s life was like prior to you (ie RSPCA case, sporting, racing, companion animal, any known injuries or traumatic events?) 
Does your animal have any vices? Nipping, cribbing, windsucking, self-mutilation, etc? 
What training methods, if any do you use? Natural horsemanship (any specific trainer’s philosophies?), classical dressage, barkbusters, etc? 
Since this animal has been with you has he suffered any illnesses or injuries? 
Any medications given at that time? How did your animal respond to this medications (positively, negatively, no response?) What vaccinations has this animal been given? When was the last time your animal was vaccinated and with what pharmaceutical, as well as any other times you can remember. Did your animal experience any reactions? 
Is your animal on any medications now? (From your veterinarian, any other therapist, or self medicated by you?) 
Are you giving your animal any herbs at the moment? (please list all - including garlic, chamomile etc) 
Your reasons for requesting a consultation? 
What would you like to achieve with your animal’s health? 
Have you tried any other therapies or therapists with this issue? 
Has your animal had alternative therapies before, please give details. 
What diet/feed is your animal currently on? 
What sort of work do you currently do with your animal (if horse – what discipline and level of competition). 
Does your animal have any observable conformation faults? 
If your animal is a horse, what sort of hoofcare does he receive? Shod or barefoot? And if you are aware what style of farriery. 
Does your animal have regularly dental check-ups? How often and when was the last examination? 
If your animal was human, how would you describe his or her personality? 
Any further thoughts that you think are significant about your animals?

Preferred method of payment:

Credit card details  [Visa] [ MasterCard] [Bankcard]

Card Number

Expiry Date

Or cheque or money order

All transactions are in Australian dollars

Mail to PO Box 670 Randwick NSW 2031

Fax 61 2 9326 5235

Email catherine@happyhorses.com.au
Do not take your animal off any medication your veterinarian has prescribed without his or her guidance and make sure you advise Catherine of any changes in medications. Some herbs will support pharmaceuticals while others will be antagonistic.

I understand acknowledge that Catherine Bird is not a Medical Doctor, Psychiatrist, Veterinarian or any other kind of Doctor of Medicine, nor does she hold herself out as one. 

Signed 

Date