Comprehensive Consultation Intake 2026

Comprehensive History Questionnaire 2026

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The Appointment Details

New Patient Appointments are scheduled each Mondays

Wait time for Appointment*

A typical wait time is 6-8 weeks --> we offer limited After-Hours appointments at a 50%

Standard Wait (6-8 weeks) ($595)

Urgent After Hours (within 2 weeks) -- ($595+ 50% surcharge)

Appointment Time Preference*

First Available

10am (pacific time)

2pm (pacific time)

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How may we reach you to confirm details?*

Call Me

Email Me

Text Me

About You and Your Pet

So that Dr. Kangas may best prepare for your comprehensive consultation, please complete and submit the information below. Notes: All questions require a response, if the answer is no or none, please simply type NONE or N/A in the prompt. Average time to complete is 10 minutes. Please be sure to have a photo of your pet available to upload.

Your Name*

First Last

Spouse/Partner/Significant Other (that you would like on record)

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Your Phone*

Your Email*

Your Pet's Name*

Species*

Canine

Feline

Breed*

Pet Coloring*

Sex*

Female Intact

Female Spayed

Male Intact

Male Neutered

Please enter your pet's birth date or approximate age*

Presenting Concern

What is the primary concern?*

Please provide more details about the primary concerns for your pet.*

What are your goals working with Dr. Kangas*

History

How long have you had this pet?*

Describe your pets' personality type/behavior?*

Medical

Please provide clinic names AND phone numbers* of veterinarians (general practice or specialists) that your pet has seen in the past 3 years.*

ie. or any references we need to obtain medical records which you consider pertinent for Dr. Kangas to review your pet's medical history. *International clients, please also provide an email address of any attending veterinarians.

When and where was bloodwork or other testing last performed? (including Microbiome, Allergy, Hair Mineral Analysis, Nutrient, etc)*

please provide approx date of bloodwork along with name and phone number of clinic where it was done *International clients, please also provide an email address of any attending veterinarians.

Please list all current and past health problems of your pet, approximate dates of symptoms and severity. Please include any treatments that were done; conventional (surgery, antibioics, steroids) or holistic (acupuncture, chiropractic, herbs, supplements)*

Do you use Heartworm Prevention?*

if yes, which product(s)

Do you use Flea/Tick Prevention?*

if yes, which product(s)

Does your pet currently take any prescribed medications? Please List*

Does your pet currently take any supplements? Please List*

Has your pet had any recent vaccines? And/or any problems or reactions to previous vaccines?*

Diet & Environment

What specifically does your pet eat?*

How long have you been feeding this diet?*

How many meals per day does your pet eat?*

What type of water do you offer your pet?*

Behavior & Exercise

How does your pet react in new situations? With new people? Does your pet exhibit anxiety, fear or aggression behaviors?*

Describe your pets' activity level and how often he/she gets exercise.*

Please submit a photo of your pet*

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB.

ensure a clear face view

Other

Do you have prior experience with any pets or humans in your household receiving any types of holistic healthcare? (and if so, what types: acupuncture, chiropractic, nutritional, etc.)*

How did you find us?*

i.e. Google search, pet health podcast or live event, referral from friend or family member, referral from veterinarian. other.

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Please select your preferred method of communication for appointment reminders*

Text Message

Call Me

We like to share our patients on social media. Do you consent to allow us to post images of your pet to our social media, including but not limited to Facebook, Instagram and our website?*

Yes

PLEASE READ AND SIGN BELOW:

By submitting this form, I authorize Integrative Veterinary Care practitioners to treat my pet.

Entry Date*