Essential Oil Therapy

We look forward to helping you and your pet with integrative veterinary care. Please complete the Essential Oil Form below.

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Essential Oils

We are so happy to meet you! We just need some information to get started. We look forward to helping you and your pet with integrative veterinary care.

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Owner's Information

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Pet's Information

Pet's Name*

Species*

Breed*

Age (Approximate)*

Gender

Female

Spayed Female

Male

Neutered Male

Weight*

Medical History

Allergies: Any known allergies or sensitivities to specific substances, including essential oils.*

Current Medications: List any medications or supplements the pet is currently taking.*

Existing Health Conditions: Note any existing health conditions or chronic issues that the pet may have.*

Household Information

Other Pets in the Household: Indicate if there are any other pets living in the same household. Please include species, breed, age, and any known health issues of the other pets*

Primary Issue/Goal

Describe the primary issue or goal for using essential oils on the pet (e.g., anxiety, skin irritation, joint pain).*

Prior Experience with Essential Oils

Have you used essential oils on your pet before? If yes, please provide details about the oils used and their effects.*

Veterinarian Information

Name and contact details of the pet's primary veterinarian.*

Consent and Acknowledgment

Consent to use essential oils on the pet and acknowledgement of potential risks associated with their use.*

I consent

Signature*

Date*

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Name

This field is for validation purposes and should be left unchanged.