Name of Owner: *

Tel No: *

Address: *

Yard Address (if applicable):

Name of Animal: *

Species:

Age:

Breed:

VETERINARY SURGEON AND PRACTICE – YOU MAY WISH TO INFORMED YOUR VET OF MY VISIT ALTHOUGH THIS IS OPTIONAL AS ALL THERAPIES ARE NON-INVASIVE

How long has the animal been in your care?

Physical condition and temperament / stereotypical behaviour?

Brief description of illness / injury / behaviours to be addressed? Please include what you hope to get out of the session. This will help ensure I can prioritise accordingly.

Date of first symptoms:

Veterinary treatment or diagnosis:

Is your animal receiving any prescribed medication or alternative support e.g. homeopathy, herbs, supplements? If so please give full details:

Have you tried any other therapies for this condition? Please state:

Are you aware of any agricultural land in the vicinity? Do you know if your yard sprays the fields (applicable for horses)?

If so do you know when this was last undertaken?

Please provide full details of your animals feeding regime, listing all feed products, treats and supplements that they receive (including where possible brand and ingredients provided on the packaging):

Daily routine and turnout / exercise programme:

Have there been any changes in behaviour during exercise in recent weeks?

Worming regime (include brand name and frequency of administration):

Vaccinations:

Any allergies:

Last dental check & by who (vet or dentist):

Please state hoof care programme (horses only):

Is any eye or nose discharge present:

If female, has the animal ever had a litter or a foal (if so what age where they weaned)?

PLEASE INDICATE WHETHER YOU, OR ANYONE ELSE THAT MAY BE INVOLVED WITH THE ZOOPHARMACOGNOSY SESSION COULD BE PREGNANT, BREAST-FEEDING, HAS A HISTORY OF HIGH BLOOD PRESSURE, EPILEPSY OR IS TAKING ANTI-COAGULANT DRUGS? *

To promote a wider understanding and acceptance of Applied Zoopharmacognosy (Self-Selection), It is often beneficial to inform your Veterinary surgeon that your animal is to be offered natural remedies on a self-selection basis only. Should they wish to discuss any aspect of this therapy, they should contact Catherine Edwards. It is important to note that most oils / extracts used have not been formally drugs tested, therefore natural remedies should be treated in the same manner as prescription medication. It is recommended that they should not be offered at least 10 days prior to any competition participation. In addition, by signing this sheet you are confirming that you have obtained Veterinary permission for Photonic Red Light Therapy on your horse. All consults may be videoed for training purposes. By signing this form you give permission for the consult to be videoed and the footage used as required by Catherine Edwards. *

Please type in your name as proof of digitally signing this document. *

Date *