Today's Date
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Are you familiar with muscle testing? What are your thoughts, experiences, or questions about the videos?
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Tell us what you think about the videos and if you have any questions/experience in holistic care.
Owner's Name
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First Name
Last Name
Email
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Occupation
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Preferred Phone Contact Number
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Mobile
Home
Work
Mobile
(###)
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Text OK?
Yes
No
Home
(###)
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Work
(###)
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Secondary Caregiver:
First Name
Last Name
Phone:
(###)
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My experience in holistic health includes:
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Nutrition Response Testing (Muscle Testing)
Reiki
Pranic Healing
Functional Medicine/Integrative Medicine
Meditation
Medical Medium Information
Nutritional Supplements
Titer Testing
Essential Oils
Distance Energy Healing
Chiropractic Care
Acupuncture
Naturopathic Medicine (ND)
Functional Nutrition
Herbal Medicine or Homeopathy
Ayurveda
Yoga or Exercise Medicine
None of the above but I am willing to learn
None of the above and I do not consider myself willing to learn
Pet's Name
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Species
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Canine
Feline
Breed
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Sex
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Female
Male
Spayed/Neutered
Yes
No
Are you willing to change to a different food for your pet?
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Yes
No
Maybe
What kind of food are you willing to feed your pet?
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Kibble
Canned
Dehydrated
Home-Cooked
Commercial Raw
Homemade Raw
Not Sure
How were you referred to our practice?
Please check your availability for coming into the office for your appointment:
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Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Friday AM
Friday PM
I understand that a $120 new patient deposit is needed to make an appointment.
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This deposit will cover the new patient appointment and creating your individualized program. Supplements are sold separately through our office.
Yes
I understand that what we offer at SAAC is muscle testing/nutrition response testing to establish an ongoing supplement and diet program to reverse chronic health issues, prevent new issues, and/or maintain overall vibrant health. This will take time and diligence to achieve. This is a program in which you will come back routinely to update the program until your pet is in our "maintenance" phase where we will see them about twice a year. I understand that we offer titer testing in place of vaccines, annual heart worm testing and medication, annual fecal testing, any necessary blood work or urine testing, and physical examinations by Dr. Sheppard. We offer a plethora of supportive supplements and natural products including flea and tick care, essential oils, ear cleaners/care, shampoos, food, CBD oils, pain relief, and more. We are teaching you a new way to take care of your pet that has shown to be successful in many ways. We should take care of the bulk of your healthy pet's needs, but you MAY need to seek conventional care if there is something we cannot provide. We do not recommend annual vaccination or excess medication for your pet. If this is what you are looking for, we are happy to have you and care for your pet. If this is not what you are looking for, we understand and with so many new clients, we are only looking for those who are in line with us or are willing and open to learn more. Please confirm by typing below.
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