Is there anything that you would like to add about your pet’s symptoms

or history?  For example, has there ever been an emotionally upsetting

event in your family that affected the pet’s attitude or activity level? _______

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Check all that apply:

FIRE

* Lively                                    * Insomnia

* Communicative                      * Separation Anxiety

* Very friendly                         * Restless

* Affectionate                           * Excess heat

* Loves to be petted                 * Rapid heart rate

* Center of the party                 * Heart problems

WOOD

* Decisive                               * Ligament problems

* Assertive                              * Liver problems

* Confident                              * Red eyes

* Strong                                   * Angers easily

* Impulsive                              * Ear problems

* Athletic stamina                    * Nail problems

* Alpha animal                        * Footpad problems

* Anal sac issues

EARTH

* Relaxed, held back               * Diarrhea

* Sociable                               * Constipation

* Round & large                      * Loss of appetite

* Loyal                                    * Vomits

* Serene & balanced               * Gum disease

* Motherly                               * Weak muscles

* Overeats, obese                    * worries

WATER

* Careful                                  * Rear weakness

* Curious                                 * Fearful

* Self contained                       * Bone & back problems

* Likes to hide                        * Urinary problems

* Meditative                            * Disturbed growth

* Slow & consistent                * Deafness

* Reproductive problems

METAL

* Loves order                          * Asthma

* Obeys the rules                     * Dry skin

* Aloof                                    * Sinus problems

* Symmetrical body                 * Breathing disorder

* Disciplined attitude              * Nose problems

* Good hair coat                      * Cough