Fill the form below and we will get back to you as soon as possible. Check on the website to see if we're backlogged. If you don't hear from us in a week, please accept our apologies and go elsewhere. 1. Your Name: * 2. Your E-mail Address: * 3. Your city and state: * 4. Your phone number: * 5. Animal Type (Canine, Horse, Feline, Other): * 6. Animal age (in years): * 7. Animal sex: * 8. When was the animal's last visit to a D.V.M.? * 9. What form of cancer or chronic illness is it? * 10. What's the D.V.M.'s prognosis? * 11. How long ago did you first start to notice symptoms in the animal? * 12. Tell me about the present condition and vitality of the animal. Is it walking? Eating? In pain? Lying around waiting to die? * 13. Tell me about the animal's normal personality and behaviors. It is normally aggressive? Destructive? Timid? Playful? What does it do all day normally? * 14. Now, what were the first mental symptom changes noted in the animal that seemed striking, odd, and unusual enough to worry? Did the animal just hide somewhere in solitude and want to die? Was it whimpering for help? Anxious? Restless? Lethargic? Unusually depressed? * 15. What kind of breed are we dealing with here? Tell me also all about this animal's diet ever since owned. * 16. How much does the animal weigh now? How much did it weigh when last healthy and when was that? * 17. Tell me about any unusual, odd, and striking discharges from the animal. Bad breath? Breath that smells like what? Foaming at the mouth? Belching? Flatulence with no foul odor? Flatulence with horrible odor? What color and constiency to the stool? Any bowel control problems? What color to the urine? Any stench to the urine? Any oddity in urinary flow, frequency, or control? How about respiration? Is it normal? Slow? Unusually fast with panting? Is the dog easily winded? Any external or internal bleeding present? * 18. Are the tumors hard and stony or soft and pus-like? * 19. Is there a history of famililal cancer in the dog's pack? * 20. Tell me about this dog's medical history, vaccination history, symptom and pathology history (Here, give me the names D.V.M.'s have given): * 21. Okay, now, in our own words describe to me the worst symptom or condition that YOU observe in the animal. I don't want to hear disease names and theories; Just the facts; Just what you see in regard to the most severe symptoms in the animal. Forgetting the cancer or ailment names, if you could cure up to 10 sufferings in this animal right now, what would they be and list them in priority order? * 22. Is there anything which seems to make any of those symptoms worse? What? When? How? * 23. Is there anything which makes those symptoms better? What? When? How? * 24. List the present medications this animal is under: * 25. In your best estimate or that of the vet, about how long does this animal have to live? * 26. For the next week, will you be available by email or telephone? When is the best time to reach you by phone? * 27. Do you agree to the Non-Disclosure and Copyright restrictions listed previously? (Yes, is the only acceptable answer.) * 28. Do you agree to the Liability Release terms stated earlier? (Yes is the only option.) * 29. This final box is not a question, but just a note. I will review your form input as soon as possible. Again, if I don't contact you within a week, please accept my apologies for the delay.