Name: Niles Animal Hospital & Bird Medical Center
Address: 7278 North Milwaukee, Niles, IL, 60714, US
Telephone: 847-647-8498
Price range: $$

HOLISTIC EVALUATION QUESTIONNAIRE

Name
First Last
Pet Name
Species/Breed
Age
Sex
Neuter/Spay
Vaccines/Date last vaccinated
Current medications/supplements
Current Medical Conditions
Reason for Holistic Evaluation
Does your pet prefer (check all that apply)
- Shade
- Sun
- No preference
Does your pet prefer (check all that apply)
- Carpet
- Hardwood
- Tile
- No preference
Does your pet prefer (check all that apply)
- Dry food
- Wet food
- No preference
Does your pet prefer (check all that apply)
- Spring
- Summer
- Fall
- Winter
- No preference
Does your pet prefer (check all that apply)
- More active during day
- more active at night
- No preference
What is your pet's personality around you/family? (ex. outgoing, attention seeking, protective, independent, shy, laid back, etc.) Please be specific.
Around strangers?
Around other dogs/cats/pets?
What is your pet's diet, including treats? Please try to be specific (brand, flavor, amount).
Untitled
- Hot
- Cold
- Dry
- Damp/Humid
- Spring
- Summer
- Fall
- Winter
- Morning
- Night
- No difference
How long has your pet's condition been going on for?
What are your expectations/goals for today's appointment and/or holistic treatment

Visit Us Today!

7278 North Milwaukee
Niles, IL, 60714

Call/Text: 847-647-9325

Fax: 847-647-8498
Email: info@nilesanimalhospital.com

Book an Appointment

Get Directions

Hours

Monday: 8:00am-12:00pm & 2:00pm-6:00pm
Tuesday: 8:00am-12:00pm & 2:00pm-6:00pm
Wednesday: 8:00am-12:00pm & 2:00pm-4:00pm
Thursday: 8:00am-12:00pm & 2:00pm-6:00pm
Friday: 8:00am-12:00pm & 2:00pm-6:00pm
Saturday: 8:00am-4:00pm
Sunday: Closed

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