Customer Feedback Form

Enter your feedback here online to go into the draw to win a month’s supply of your HomeoPet product

ANXIETY
For emotional states,travel and motion sickness, seperation anxiety, fretting, fear of being alone, veterinary visits, grooming, unwanted behaviour, hysteria, excessive barking, drooiling, thunderstorms and loud noises.
JOINT RELIEF
Use for arthritis, joint inflammation, musculoskeletal pain, lameness, pain from injury. Improves mobility, stiffness, osteoarthritis and chronic degenerative myelopathy.
DIGESTIVE UPSETS
For stomach upsets, diarrhea, vomiting, nausea, colic, indigestion, abdomen pain, gastroenteritis, appetite stimulation and digestive strengthener, flatulence, bloating and smelly breath.
SKIN & ITCH
For Atopy or allergic conditions. Chronic pruritis, allergic dermatitis, eczma, pyoderma when allergy related. Skin irritations, rashes, prickly or violent itching, wet or sticky broken skin from licking or chewing, scabs, smelly skin.
SKIN & SEBORRHEA
SEBORRHEA OR OTHER ALLERGIC CONDITIONS
Chronic pruritis, grass, pollen, house-dust allergy, allergic reactions to drugs or vaccines, allergic dermatitis, oily greasy coat, dry flaky coat (dandruff like), strong odors from ears and ear discharge. May be used as an adjunct treatment in mange. Also can be used as a support treatment of eczema, pyoderma, and chronic itching.
HOT SPOTS
Dermatitis, red dry flaky hot spots, hair loss from chewing and licking, sores and infection, rash, smelling skin and oozing or itching skin.
FLEA BITES
For relief of itching when associated with flea bites, allergic dermatitis caused by fleas, bugs and insect bites.
LEAKS
Treats urinary incontinence, incontinence from fear or excitement, frequent urination. For use with younger or older animals and after neutering or spaying.
NOSE REFIEF
For catarrhal discharge, nasal infection, dry crusty noses, irritation of nasal passages, rhinitis, sinus and upper respiratory tract infection.
COUGH
For spasmodic dry cough, swollen glands, harsh non-productive cough, kennel cough, croupy cough, hoarseness.
FIRST AID
Use for wounds, trauma, sprains, broken bones and fractures, injury, dental work, punctured tissue, nerve injury and painful broken wounds. After surgery.

	* Required Fields
Product Used

Administration
HomeoPet’s individual homeopathic formulas are delivered in 15ml dropper bottles. Each bottle contains 350 drops. Optimally the dose should be dropped directly into the mucous membrane of the mouth for absorption. Doses may also be administered in food or placed on a treat, into water or milk. Privacy Statement We acknowledge and respect your privacy. The feedback given here is solely for the purpose of clinical trials on behalf of HomeoPet for the Australian Pesticides and Veterinary Medicine Association (APVMA) and will not be disclosed to any third party.

Owner Information
* Name:
* Email:
Address:
* State:
Post code:
Phone:


Pet Information
Name:
Pet Type:	Dog Cat Other
	If "Other" please specify
Pet Gender:	Male Female Neutered
Age:
Weight (kg):
Pet Breed:


Symptoms



Additional Information



Prior Treatment
Type of Medication:
Has it been discontinued:	Yes If Yes, why?

Describe response to medication:


HomeoPet Treatment
How dosed:	Mouth Food Water
Number of Drops:	If "Other" how many?
Times Daily:	If "Other" how many?

Response Observed:	No Yes
Response Time:	Please select one


Comments in your own words / Observations?



In your opinion was the product dosed correctly?	No Yes
Have you used another HomeoPet product? Please select which one	If yes. Please submit another feedback questionnaire for other products used.


Veterinarian Information
* Name:
Clinic:
Address:
Phone:
Email:
Thank you.
Your feedback and participation enables HomeoPet to gather valuable data and information to continue investment in the quality and range of products we provide.

PRODUCTS

Customer Feedback Form

Product Used

Administration

Privacy Statement

Owner Information

Pet Information

Symptoms

Additional Information

Prior Treatment

HomeoPet Treatment

Comments in your own words / Observations?

Veterinarian Information

Thank you.

For emotional states,travel and motion sickness, seperation anxiety, fretting, fear of being alone, veterinary visits, grooming, unwanted behaviour, hysteria, excessive barking, drooiling, thunderstorms and loud noises.

Use for arthritis, joint inflammation, musculoskeletal pain, lameness, pain from injury. Improves mobility, stiffness, osteoarthritis and chronic degenerative myelopathy.

For stomach upsets, diarrhea, vomiting, nausea, colic, indigestion, abdomen pain, gastroenteritis, appetite stimulation and digestive strengthener, flatulence, bloating and smelly breath.

For Atopy or allergic conditions. Chronic pruritis, allergic dermatitis, eczma, pyoderma when allergy related. Skin irritations, rashes, prickly or violent itching, wet or sticky broken skin from licking or chewing, scabs, smelly skin.

Dermatitis, red dry flaky hot spots, hair loss from chewing and licking, sores and infection, rash, smelling skin and oozing or itching skin.

For relief of itching when associated with flea bites, allergic dermatitis caused by fleas, bugs and insect bites.

Treats urinary incontinence, incontinence from fear or excitement, frequent urination. For use with younger or older animals and after neutering or spaying.

For catarrhal discharge, nasal infection, dry crusty noses, irritation of nasal passages, rhinitis, sinus and upper respiratory tract infection.

For spasmodic dry cough, swollen glands, harsh non-productive cough, kennel cough, croupy cough, hoarseness.

Use for wounds, trauma, sprains, broken bones and fractures, injury, dental work, punctured tissue, nerve injury and painful broken wounds. After surgery.