Consultations For Country Park Animal Herbs Customers

Special Offer for Country Park Animal Herbs Short Consultations   $40.00 15 minute telephone advice to assist you to decide what herbs and blends to purchase for your animal.

Full Consultation   $70.00 Includes up to 60minute phone consultation. You receive a typed program with formulations and monitoring of your animal’s issue.

Payment can be made with credit card or money order (payable to Catherine Bird) at the time of submitting your request for a consultation on our form. If you do not have access to a printer one can be faxed or mailed to you upon request.  

Appointments may be necessary to provide you with the best possible service and you will be contacted once we receive your form with an appointment time to phone Catherine. Some short consultations may not require you to fill out this form, however the more information you are able to provide, the quicker we can provide you with advice
please copy and print out the below form

Owners Details

 

Name

 

Address

 

   

BH Phone

Fax

Email

 

Date of Birth

Referred by 

 

 

Animals Details

 

Pet or Stable Name

Species 

Breed

Age

Sex

Hands or Weight 

Date of Birth if available

 

 

 

Your reasons for requesting a consultation? 

 

 

 

 

 

 

 

 

Veterinarian’s Name
Practice Address
Phone Number
Email (if known)
Do I have your permission to contact your veterinarian - YES or NO

 

 

 

What is your veterinarian’s diagnosis and prognosis? 

 

 

 

 

What is the problem as you see it?

 

 

 

 

 

 

 

 

 

 

How long have you had this animal? 

 

 

 

Are you the only handler of this animal, or are others feeding, grooming, riding, working, training? 

 

 

 

Does your animal have any vices? Nipping, cribbing, windsucking, self-mutilation, etc? 

 

 

 

 

Since this animal has been with you has he suffered any illnesses or injuries? 

 

 

 

 

 

Any medications given at that time? How did your animal respond to this medications (positively, negatively, no response?) What vaccinations has this animal been given? When was the last time your animal was vaccinated and with what pharmaceutical, as well as any other times you can remember. Did your animal experience any reactions? 

 

 

 

Is your animal on any medications now? (From your veterinarian, any other therapist, or self medicated by you?) 

 

 

 

Are you giving your animal any herbs at the moment? (please list all - including garlic, chamomile etc)

 

 

 

 

What would you like to achieve with your animal’s health? 

 

 

 

 

 

 

 

Have you tried any other therapies or therapists with this issue? 

 

 

 

 

 

 

 

Has your animal had alternative therapies before, please give details. 

 

 

 

What diet/feed is your animal currently on?

 

 

 

 

 

 

 

What sort of work do you currently do with your animal (if horse – what discipline and level of competition). 

 

 

 

 

 

Does your horse have any special needs such as training, farrier or dentistry not previously mentioned?

 

 

 

 

 

 

If your animal was human, how would you describe his or her personality? 

 

 

 

 

 

 

 

 

 

Any further thoughts that you think are significant about your animals?

 

 

 

 

 

 

  • Method of Payment -
  • Credit card details  [Visa] [ MasterCard] [Bankcard]
    Card Number    _____ _____ _____ _____ _____
    Expiry Date      _____ / ______
    Name on Card_____________________________________________

  • Money Order made payable to “Catherine Bird”

I authorise my credit card to be debited for $_____________

  • Short Consultation $40.00

  • Full Consultation    $70.00

Do not take your animal off any medication your veterinarian has prescribed without his or her guidance and make sure you advise Catherine of any changes in medications. Some herbs will support pharmaceuticals while others will be antagonistic.

I understand acknowledge that Catherine Bird is not a Medical Doctor, Psychiatrist, Veterinarian or any other kind of Doctor of Medicine, nor does she hold herself out as one. 

Signed____________________________________    Date   __ __ _____

Please Note: Advice is not a substitute for medical or veterinary treatment!