Initial consult questionnaire

Please fill out this consult form completely and accurately. 
Upon receipt of this completed questionnaire, I will be in touch to set up your consult.

Name *
Name
Phone number *
Phone number
Address *
Address
Referred by *
Is your dog spayed or neutered? *
How do you prefer to consult? *
Briefly describe your diagnostic questions, medication questions or general questions. More information will be covered in the consult itself.
Please include any and all previous health history that would be helpful in regard to your question or concern listed above.
Are you interested in learning more about alternative options? *
Are you interested in learning more about incorporating alternative support such as flower essences, supplements or homeopathy?
DISCLAIMER: *
The purpose and general goal of Doggie Decipher consultations offered by Gina Snow LVT is to educate the client about their dog’s diagnosis and help outline the results and treatment options. Gina Snow LVT does not function as a veterinarian by diagnosing disease, treating disease, or performing invasive procedures, nor do her services replace that of a licensed veterinarian. The information offered by Gina Snow LVT is intended to provide general guidance. Nothing on the website or during a consultation constitutes veterinary advice. Always consult with a licensed veterinarian before undertaking any course of treatment for your animal or changing treatments or medications your own veterinarian has already prescribed. This consultation will hopefully suggest additional options to think about, and other areas to explore, based on your dog's condition. Any information discussed needs to be considered suggestions which should be discussed with your primary veterinarian.
Fee Schedule *
Fees are based on time: 0-15 minutes $25.00 (acute issues-simple), 16-30 minutes $40.00 (acute issues-complex), 31-45 minutes $55.00 (chronic issues-simple) and 46-60 minutes $70.00 (chronic issues-complex). Please submit payment by going here: paypal.me/doggiedecipher
Please select your preferred consult time: *
Please check the box of the consultation time you believe is appropriate. After submitting this form, be sure to remit payment by going to paypal.me/doggiedecipher
Please type the date. *
Please type the date.