Rainbows & Butterflies
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Name of Animal
Name of Animal Owner
City
Zip Code
Country
Type of animal
Breed or subspecies
Age
Weight
Gender
Male
Female
Workload (for horses only)
Light
Medium
Heavy
Main Health Problems
Recent Medical Tests/Surgeries
Main Brand(s) Of Feed:
Nutritional Supplements
Medications
How Often Do You Give Treats?
List Treats
SYMPTOMS:
Allergies
Hives
Skin_Problems
Fungal_Infections
Joint_pain/stiffness
Muscle_pain/soreness/weakness
Ligament_Problems
Fractures
Fatigue
Weight_Gain
Weight_Loss
Hair_Thinning_or_Loss
Urination_Problems
Fever
Cough
Nasal_Discharge
Sugar_Reactions
Slow_Wound_Healing
Cataracts_or_Eye_Problems
Hoof_Issues
Tooth_Decay
Gum_Disease
Slow_Eating
Poor_Appetite
Skin_Growths
Dull_Hair_Coat
Other_Coat_Problems
Constipation
Diarrhea
Colic
Ulcers
Tumors
Anger/Aggression
Anxiety/Fear
Confusion
Irritability
Moody
Panic_Attacks
Hyperactivity/Easily_Spooked
Hypoactive/Lethargy
Dull
Sleeps_A_Lot
Which symptoms concern you the most.
Other Symptoms.
Is this a retest
Yes
No
If this is a retest, what changes have you noticed
How do you want your results delivered
Email
Regular Mail
Pleae provide the addres to use for your delivery (enter either email or physical)
Submit
