Checkbox *

Mrs.

Mr.

Ms.

Dr.

Owner's Name *

First Name

Last Name

How did you hear about us?

Online/Website

Primary Veterinarian

Instagram

Facebook

Other

How much experience do you have with Chinese or Alternative/Contemporary/Holistic medicine? *

I am experienced and very familiar with the concepts

I've heard about it and am open to options

I am not familiar with it and would love to learn more about how it benefits my pet

Payment is required at the time of service. For your convenience, we accept PayPal, Venmo, Mastercard, Visa, American Express, cash, or check (with a valid driver’s license). *

Cash

Check

Debit/Credit

How much information do you want to be given about your pet’s health? *

I want a full explanation—anything and everything.

I want a brief explanation—just the important stuff

I just want to know if there’s anything I need to do—keep it simple.

You will be asked to sign a health plan confirming authorization of treatment after a tentative diagnosis. The details of treatment, the risks of treatment, and/or the risk of not treating will be explained to you. *

I have read and understand.

Pet's Sex *

Male

Female

Has your pet ever shown aggression to humans or other animals? *

Yes

No