Acupuncture Form

Note: All necessary forms and records are required prior to your visit

Client/Patient Questions

Preference for temperature: (cold, warm, neutral)

Likes to sleep on cool tile or warm carpet?(Required)

Pants even when in air-conditioning?(Required)

Likes to lay in the sun even when it is hot?(Required)

Easily adapts to surrounding temperature?(Required)

Seems to be intolerant of heat?(Required)

Seems to be intolerant of cold?(Required)


Likes to sleep on the hard floor?(Required)

Likes to sleep on a soft bed?(Required)


Startles easily with loud noises or sudden movements?(Required)

Reaction to new situations or people?(Required)

Personality types of TCVM

Each animal, and human, is a combination of all 5 elements. However, each of us has a predominant element that defines us. See if one of these describes your dog or cat’s personality more than the others.

Fire: extremely friendly, greets strangers warmly, noisy/barking/talkative/excited/hyper­excitable, center of attention, difficult to keep still, sensitive to needles, extremely extroverted.

Wood: arrogantly confident, irritable/crabby, active/energetic/athletic. Aggressive/angryr, competitive, bites with little provocation, impatient, extroverted.

Earth: friendly, enjoys sleeping and eating, eager to please owner, slow to react, laid-back, easy-going, worries for others, extroverted or introverted.

Water: fearful, quiet, not confident, watches what the vet is doing, normal or nervous in the exam room, but aggressive at home. Extremely introverted.

Metal: aloof, quiet, confident but not arrogant, disciplined, follows the rules, organized, hides emotions, introverted.

Thank you for taking the time to help me know your furry family member better! I look forward to working with you!


Carroll Garland

Certified Veterinary Acupuncturist, DVM