Holistic Questionnaire Thank you for choosing Ness Exotic Wellness Clinic. In order to personalize your experience and have a clear client profile, we need you to fill out our Holistic Questionnaire below. Your data is safe with us.Today's date Birth Date of PetGender of PetMaleFemale Date of Onset Current MedicationsCurrent Supplements:GENERAL BEHAVIORSeeks/PreferenceHeatColdNo DifferenceActivityNormalDecreasedInactiveHyperactiveSleep PatternsRestfulExcessDisturbed/RestlessDreamsInteractions (People)NormalAggressiveAvoidanceFearfulInteractions (Animals)NormalAggressiveAvoidanceFearfulVACCINATION HISTORYDate of Last VaccinationWhich vaccinations?Vaccination Side Effects?YesNoIf so, please describe.Vaccine Titers?YesNoTiters Details:DERMATOLOGIC CONDITIONHair/CoatNormalThinDryOily/GreasyDandruff/Flaking Describe Amount/AreaSkin ConditionNormalDryScalyItchyOther Describe Amount/AreaSkin Lesions/SoresYesNoLocation of LesionsAppearanceRashRednessDiscolorationDischargeDescribe ApprearanceMUSCULOSKELETAL HISTORY Body CompositionNormalLeanThinOverweightObeseMuscle ToneNormalWeakTense Overall StiffnessAcuteChronicNoneStiffness Worse with:DampnessHeatColdStiffness Worse upon:Lying DownExerciseOverexertionOverall PainAcuteChronicNoneBetter with:MovementRestNothing IMMUNE SYSTEM HISTORY Describe Allergy:Frequent Infections?YesNo Other Comments:RESPIRATORY HISTORYBreathingNormalLaboredShallowCongested CouchSneezeWheezeGagging Nasal DischargeYesNo DIGESTIVE HISTORY AppetiteNormalRavenousDecreasedNoneAccepts Treats?YesNo List treats or snacks fed...ThirstNormalIncreasedDecreased Describe changes & severity:BOWEL MOVEMENT CharacterNormalLooseDiarrheaConstipated Vomiting?YesNoFrequencySporadicAfter MealAfter Eating GrassAfter Meds When did it start?URINARY TRACT HISTORY DifficultyNoneStrainingDribbles CharacterClearCloudyUrinalysis ResultsREPRODUCTIVE SYSTEMNeuteredYesNo If not, bred?YesNoSuccessful LitterYesNoWhen?Genital Discharge?YesNo Other CommentsNERVOUS SYSTEMBalancing Issues?StumblesUnsteady on FeetCirclingFalls to Side (left)Falls to Side (right)Tilt HeadLeftRight Headache?Avoids LightSquints EyesResists Petting of HeadEating ProblemsTwitching? Seizure? VETERINARY HISTORY Previous Records Requested?YesNoSent to Ness Exotic Wellness Center?YesNoWhen Received?Blood Work?YesNoRadiographs?YesNo