Essential Oil Therapy Consultation Form

Name and address of Owner:

Telephone number:
e.mail:

Temperament:

Case Veterinary surgeon and address of Veterinary practice:

Details of symptoms and general demeanour:

Possible causes:

Has the animal had this condition before? Please give details:

Veterinary diagnosis (if applicable):

Results of blood tests (if applicable):

Veterinary treatment and present medication if applicable (please finish course of any prescribed drugs before commencing Essential Oil Therapy):

Details of any previous trauma, accident or illness:

Any known allergies:

Previous respiratory problems:

Digestive problems:

Regularity of bowel movements and consistency:

Water consumption:

Condition of skin/coat/nails/hoof:

Teeth/gum condition:

Stereotypical behaviour or habits:

Known background: (where bought from, how long owned, general history etc):

Socialisation? Hierarchical position (if applicable):

Details of exercise/turnout/daily walks:

Fitness level:

Energy level:

If horse is it stabled, what type of bedding is it on (paper, shavings, straw, rubber matting etc):

If dog, where does he/she sleep (owners bed, kennel, own bed in kitchen etc):

Present feed including any treats and supplements:

Appetite:

Any other complementary therapy the animal has received and date of last treatment (eg. physiotherapy, acupressure, homeopathy etc):

If horse, date of last back check: (Please give details of practitioner, result and any treatment given):

Is the animal wormed? Please give date of last treatment, product used and results of any faecal egg count:

Is the animal vaccinated and against what diseases:

Date of last dental check:

Other routine treatments eg fleas:

Date of last saddle check: (Please give details of saddler and any recommendations made):

Shod or barefoot and shoeing/trimming interval:

Any other relevant information:

IMPORTANT