Wellness Consultation

with Kymythy R. Schultze

Please Read This Page!

We want your consultation to be a positive experience for everyone involved. 

To achieve this goal, please read and adhere to the following:

1.  If this is an emergency, please contact your local primary care physician or your local emergency facility.

2.  Consultations are available for dogs, cats, and humans.  If you are requesting a consultation for a dog or cat; please read Kymythy’s book Natural Nutrition for Dogs and Cats: The Ultimate Diet before you schedule a consultation.  The book is available at many bookstores, pet supply stores, and through Kymythy’s website at www.kymythy.com   We want to save you time and money!  You may find that after reading the book, your questions are answered, and you no longer require a private consultation. 

3.  Consultation fees are $100 per hour.  Additional time is $25 per 15 minutes.

4.  If you must cancel your scheduled appointment, we ask that you please give 48 hours notice by calling 360-620-6393.  Your consultation fee will be put towards a different time.  No refunds are given once a consultation is scheduled.

 
How to Schedule the Consultation:

1.   See #2 above.

2.   Fill out the consultation forms completely and clearly.  There are six pages for you to read.  Your signature is required on page six.

3.   Mail completed forms (consults cannot be scheduled without your signature on page six) with check or money order (US funds) for $100 made out to Kymythy Schultze to:  Kymythy Schultze, P.O. Box 1881 Poulsbo, WA 98370.

4.   Once we have received your forms and check, we will contact you to schedule a consultation time that is convenient for you.

Wellness Consultation Form

Kymythy R. Schultze, Clinical Nutritionist & Animal Health Instructor

P.O. Box 1881, Poulsbo, WA 98370  

www.kymythy.com      360-620-6393

 
Please PRINT VERY CLEARLY                                         Date                                                                

Your Name                                                                                                                                         

Address                                                                                                                                              

City                                                                  State                           Zip Code                                

Phone   (           )                                               E-Mail Address                                                           

Animal Companion’s Name                                                                              Age                            

Species                                                            Breed                                                  Weight           

Sex                              Spayed/Neutered                    If yes, when                                                    

Referred By                                                                                                                                         

Please examine your furry friend very closely and give as much exact detail as possible about the condition of the following areas.  Note any discharge, odor, color, parasites, etc. and which side of animal it occurs on.  Use additional paper if necessary.

Nose                                                                                                                                                   

Teeth & Gums                                                                                                                                     

Eyes                                                                                                                                                    

Ear: left                                                                                                                                                

Ear: right                                                                                                                                              

Skin                                                                                                                                                    

Hair/Coat                                                                                                                                            

Muscle Tone                                                                                                                                       

Stools                                                                                                                                                  

Behavior                                                                                                                                              

Is your animal companion over- or under-weight?                                                                                 

How much and what type of exercise does your animal companion receive?                              

Do you and your animal companion participate in any special activities?  If yes, what?               

Has your animal companion been diagnosed with any health problems by a veterinarian?                       

Details                                                                                                                                                 

Is your animal companion currently taking medication?  If yes; what & for how long?                

If your animal companion has ever been given medication, list type and dates given                    

Vaccination history (type/date)                                                                                                 

What, if any, anti-parasite products do you use on your animal companion?                              

How often is this used/applied?                                                                                                

What type of environment does your animal companion live in? (indoor/outdoor/grass/gravel/etc.)

Exactly what does your animal companion eat at the present time (include treats):

Brand/type/ingredients/amounts & how often/supplements and their ingredients?

How long have they eaten the current diet?                                                                                           

Why are you interested in nutrition for your animal companion?                                                 

What are your goals, health and otherwise, for your animal companion?                                    

Any other symptoms, comments, or details                                                                                           

Agreement & Understanding Prior to Consultation with Kymythy R. Schultze

Prior to retaining the services of Kymythy R. Schultze,

I certify by my signature that I clearly understand the following:

            I understand that Kymythy Schultze is not providing veterinary or any other type of medical services. I will not consider anything she says or writes to substitute in any way for consultation, diagnosis, and/or treatment by a licensed veterinary or medical physician. Kymythy Schultze is not a licensed veterinary or medical doctor, nor does she diagnose, prescribe, or treat symptom, defect, injury, or disease. This consultation is for educational purposes only. If I want veterinary or medical advice or treatment, Kymythy Schultze encourages me to consult with a licensed veterinary or medical doctor. Kymythy Schultze shall have neither liability or responsibility to any person, pet, or entity with respect to any loss, damage, or injury caused, or alleged to be caused, directly or indirectly by the information in this consultation. I consult with Kymythy Schultze in her capacity as a Nutritionist who conveys self-help information that people may use to increase their or their animal companion’s health and well-being. I affirm my right to self-health and I take full responsibility for my own and my animal’s health and healing process.

Signature:                                                                                                         Date:                          

Print Full Name:                                                                                                                                   

Address:                                                                                                                                              

Telephone:        (                       )                                                                                                          

To receive a Wellness Consultation:

Mail completed form with your signature and a check or money order for $100, payable in US funds, to:
 

Kymythy R. Schultze

P.O. Box 1881

Poulsbo, WA 98370

Here’s to greater health & happiness for you & your animal friends!