CUSTOMIZED ACUPRESSURE PATTERN REQUEST

Be certain to include all requested information as to your assessment of your pet's physical, emotional and mental condition for which you are seeking assistance.

Mark an X on the spot(s) corresponding to the place on the body of your pet that you are frequently made aware of because it feels different to you or gives it problems. Circle those spots marked with an X which give your pet constant discomfort. On the lines below describe any details about your pet's emotional, mental and/or physical condition you wish addressed in the customized acupressure pattern to be designed. Including any diagnoses that has been made by a licensed Health Care Provider or similar information in your own words would be most helpful. Be as specific as you can be. (Use reverse side as needed).

Remember, the suggestions prepared for you are to be considered as supplemental to your pet's present health care program and not a replacement for the care of your pet's regular veterinarian or health care provider.

Your Full Name:

Street Address:

City:

State:

Zip:

Pet's Name:

Type/Breed of Pet:

Phone Number*:

E-mail Address*:

*To be used in case there is a question about your order.

I would like to receive ____ Customized Accupressure Pattern(s) for my dog.

Enclose a Check or Money Order payable to Anderson & Associates for US $35 (includes shipping and handling) for each customized pattern requested. Each order includes a "by appointment only" 10 minute phone consultation with Dr. Anderson. Please Do Not Send Cash. Expect a 5 to 10-day return time from the time your request and fee are received.