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To order
a personalized remedy for your pet, please fill out the questionnaire
below. Based
on the information supplied, a
personalized remedy
will be recommended via e-mail to suit your pet's needs. To order your Practitioners Choice remedy, click here and fill out our Order Form.
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E-mail:
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Required
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Name:
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Address: |
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Phone
(H): |
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Phone
(W): |
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Mobile: |
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Family
Members:
Sex/Age
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Animal Members:
Species/Breed/Age
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Name: |
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Age: |
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Breed/Species: |
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Sex: |
Male
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Female
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Desexed
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Age
of Animal When Obtained: |
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Obtained
From: |
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Please Tick the appropriate boxes |
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Does
your animal conceal distress behind an apparently normal exterior
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Is
your animal 'jumpy', 'edgy' or spook easily |
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Displays
uncertain, erratic behaviour |
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Weak
willed and lack assertiveness |
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Fails
to learn from past experiences, repeats the same mistakes |
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Attention
Seeker, clinging behaviour, lacks confidence |
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Lacks
interest in present circumstances |
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Is
very unclean |
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Feels
inadequate or overwhelmed by situations
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Does
your animal become discouraged or give up easily |
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Is
your animal bad tempered, snaps at you, seeks revenge |
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Tired,
weak, or sick. Has an inability to cope due to weariness |
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Exhausted,
worn out but never gives up |
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Appears
to be giving up, lack energy |
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Down
in spirit, depressed for no known reason |
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Lacks
cooperation, is impatient |
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Over
protective, suffers excessive fear and anxiety for others |
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Has
difficulty adjusting to new circumstances |
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Does
your animal seem over enthused or acts impulsively |
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Is
it dominating, a bully or territorial |
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Tends
to Sulk |
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Is
your animal restless or suffers from obsessive behaviour |
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Tends
to be withdrawn or reserved especially when ill |
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Has
great abilities but lacks direction |
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Lacks
confidence, has a fear of failure |
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Does
your animal have a
fear of a specific nature: |
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Has
your animal ever suffered any form of
shock or trauma: |
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Further
comments
regarding your animals behaviour: |
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