Client Information Form

Spouse/Partner's Name
Home Address(Required)
Check your primary contact number(Required)
Please note that we send monthly e-newsletters containing articles and promotions from our doctors.
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How did you hear about Alternatives for Animals?
Alternatives for Animals is a holistic veterinary wellness center focusing primarily on Traditional Chinese Medicine, Bioresonance therapy, K-Laser therapy, chiropractic, massage, homeopathy, Bach Flower remedies, and pulse signal therapy. Certain pharmaceuticals are prescribed when necessary. Should patients require anesthesia, radiographs, surgery or other in-hospital procedures, you will be referred to your conventional veterinarian, or to a full-service veterinary hospital in the city of your preference.


Client Name(Required)
Patient Name(Required)
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Any history of food or drug sensitivity?
Does weather, season or time of day affect the symptoms of the main complaint?
Does your pet have any fears or phobias?

Vaccine history:


Review of Symptoms:

Gastrointestinal tract: (Check all that apply)
Respiratory: (Check all that apply)
Cardiovascular: (Check all that apply)
Musculoskeletal: Stiffness?
Musculoskeletal: Soreness?
Musculoskeletal: (Check all that apply)
Integument/Skin: (Check all that apply)
Urologic (Check all that apply)
Head, ears, eyes, nose, throat: (Check all that apply)
If having discharge from eyes, which eye?
If ear infection, which ear?
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Neurological (Check all that apply)
Emotional Wellbeing (Check all that apply)

General physical signs: Please describe your pet's characteristics with the following: