Please review the new patient questionnaire below. If you do not have time to complete it in your browser in one sitting, download the form so you can take your time filling it out. Please email your completed form to museholisticvet@gmail.com.

If you would like to schedule a new patient consult please complete the intake questionnaire form below. Using a computer is recommended as some people have had problems when using a tablet or phone. Once we receive the completed form back we will email you within 3-5 business days to schedule an appointment.

Please understand holistic medical care is a process and can take time. There may be multiple rechecks and being committed to the process is essential in achieving the maximum benefits.

Please Note: We DO require that you maintain a relationship with a general veterinarian to help you take care of urgent issues, diagnostics and surgery that we cannot perform.

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Client Information

Client's Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Cell Phone

Home Phone

Work Phone

Email*

Pet Information

Pet's Name

DOB/Age

Weight

Species

Canine

Feline

Sex

Female

Male

Spayed/Neutered

Yes

Breed

Color

Current regular veterinary clinic and any specialists

Presenting Concerns

What is the reason for your upcoming appointment?

Why did you decide to seek holistic/alternative care for your pet?

What are the goals you hope to attain by working with Muse Holistic Vet Care?

History

Age when pet was acquired?

Where did you acquire your pet (ie: breeder, pet store, rescue, shelter, stray)?

Why did you choose this individual pet?

What other pets are in the household? Do they get along?

Medical

Does your pet have a current, specific medical problem?

Do you use heartworm preventative (if so, what kind and how often)?

Do you use flea/tick preventative (if so, what kind and how often)?

Does your pet take any current medications? If yes, list dosage, frequency and duration:

Does your pet take any supplements? If yes, list specific products, dosage, frequency and duration:

Please list a summary of the vaccines that your pet may have had in their life, please be specific and note frequency

Diet/Environment

What specifically does your pet eat (home-prepared, raw, kibble, canned). Please be very specific:

How long have you been feeding this diet?

How many meals per day does your pet eat?

Quantity of food fed?

Would you be willing to cook food for your pet?

What kind of treats does your animal eat (include everything):

Is water available at all times, how often is it changed, what kind of water (bottled, filtered, tap)?

Any dietary sensitivities or food allergies?

How often do you wash the food and water bowls?

Does your pet have any unusual cravings (ie. Grass, dirt, rocks, feces, plastic, metal)?

Have there been any major changes in the pet’s household environment (moving, marriage, death of other pet or human, divorce, new pet)?

How would you describe the household environment for your pet (ie. Calm, stressful, chaotic, mellow, lonely, crowded)?

Behavior

Personality type/behavior (check all that apply)

happy

grouchy

moody

sensitive

shy

dominant

submissive

aggressive

prefers routine

easy going

needy

stubborn

pushy

fearful

energetic

hyperactive

gets along with people

gets along with cats

gets along with dogs

Comments

Is your pet aggressive? If so, in what situations?

Does your pet have any anxieties? (separation, loud noises, etc.)

How does your pet react in new situations? With new people?

Grooming

Is your pet groomed? If yes how often?

How often is your pet bathed?

What shampoo or conditioners are used?

What other skin care products are used?

What ear cleaners are used?

On a scale of 0 to 10, how itchy does your pet seem? (0 = no itch, 10 = constant itching)

What symptoms of itchiness do you notice? choose all that apply:

Chewing

biting

licking

scratching themself

Exercise

How does your pet get exercise (ie. Leash walks only, beach, agility)?

How often and how long?

Does your pet have free access to the outdoors, if so how big is the yard?

Describe a typical daily schedule for your pet:

Would you be willing to massage your pet on a daily basis?

Environmental Exposures

What types of cleaners and detergents do you use in your home?

What type of products do you use in your lawn and garden?

What do you use for pest control?

Air Quality

Do you use air fresheners in your home, candles, or incense?

Do you use an air purifier?

Do you smoke or vape inside the house?

Do you have an air conditioner or leave windows open?

Do you think your home may be moldy?

Is your home dusty?

Other

Please list all the people and animals currently living in the household:

Does anyone in the household receive holistic medical treatment (ie. Acupuncture, chiropractic care, massage, supplements), if yes please describe:

Personality, emotions – fear, anger, depression, mania, anxiety, etc. Has there been any trauma in the animal’s life? (There always is, even if we don’t perceive it as trauma)

How is the patient sleeping?

Do they have a temperature preference – seeking warmth or cool?

What profession do you work in?

How about other family members?

Clinic Communication Consent*

Occasionally we will send an email out with important clinic updates.

I agree to receive emailed clinic updates and communications. I understand I can opt out at any time.

Dr. Barrett Newsletter Consent*

Dr. Barrett sends out a periodic newsletter with helpful information to help you and your pet. Please opt in, if you would like to receive his newsletter.

I agree to receive a periodic newsletter from Dr. Meghan Barrett. I understand I can opt out at any time

I do not wish to receive a periodic newsletter from Dr. Meghan Barrett

Social Media Consent*

I hereby give Dr. Meghan Barrett Veterinary permission to take photographs and videos of my pet for the purpose of Dr. Meghan Barrett Veterinary posting on social media accounts (Facebook, YouTube, Twitter, and Instagram) and their clinic website. I hereby release and discharge Dr. Meghan Barrett Veterinary from any and all claims arising out of use of the photos. In the aforementioned social media accounts and website, Muse Holistic Vet Care also has my permission to use my name and my pet’s name for the purposes of social media promotions.

I do not give Muse Holistic Veterinary Care permission to take photographs and videos of my pet for the purpose of Muse Holistic Veterinary Care posting on social media accounts (Facebook, YouTube, Twitter, and Instagram) and their clinic website.