Essence Trial Intake form

This is a short questionnaire to gather your cat's background information and history to assist with participating in the essence trial.

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What is your cat's name?

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What is your cat's gender?

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What is your cat's month and year of birth?

Please estimate your cat's month and year of birth if not known. Please use the format month and year for example May 2017

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What is your cat's breed?

If the breed is mixed or unknown please answer mixed or unknown.

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What aspects of your cat's emotions or behaviours do you find most challenging?

This understands your cat's needs and helps us to match the right trial blend to meet those needs.

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Is your cat currently on any medications or receiving any other form of treatment?

This helps us to understand more about their medical history and current medications or conditions being treated, as well other therapies your cat is experiencing.

Yes my cat is currently taking medication OR receiving other treatment. .

No my cat is not currently taking medication OR is not receiving any other treatment.

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If your cat is taking medication, please provide details of the medication(s) OR other treatment. If your cat is not taking medication or receiving any other treatment please click submit and move to the next question.

Flower essence therapy does not inferfere with medications or other treatments but it is helpful to understand any current medications that your cat is taking or treatment they are receiving. Please click Submit without a response if your cat is not taking medication or receiving any other treatment.

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Please provide a description of your cat's overall state of health. Please mention any specific medical conditions, allergies or sensitivities or diagnosed conditions.

This helps us to understand whether your cat has an existing medical conditions or aspects of their health that are important for us to be aware of. This may result in recommendation for a specific dosage or method of use.

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What are your cat's current symptoms? Is there a history of recent loss or bereavement, abandonment or past trauma, abuse or neglect.

Please provide information on your cat's emotions, behaviours or experiences in their past that are relevant to their current state of wellbeing.

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What would you like to achieve for cat by using the essence?

Please share what you would like to achieve for your cat in terms of emotional, physical and wellbeing goals.

Submit Email

Please share your email so that we can contact you directly to gather the address details on where to send your cat's essence blend and to provide you with further information about the trial. Your email will only be used to communicate with you about the trial and not for marketing purposes.

Thank you again for your interest.

Please fix the errors below and submit again

Email*

Thank you for your interest in trialing our new essence blend

Thank you so much for your interest in trialing our new essence blend and for sharing with us information about your cat.

We appreciate the time you have taken to share this information.

After this you will receive an email requesting your address details and your essence blend will be sent to you alongside further instructions on use and dosage and details about the trial.