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Intake
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Step
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Pet Parent's/Parents' Information
Pet Parent's Name(s)
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Pet Parent's Name(s)
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Last
Address
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Address Line 1
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City
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Alabama
Alaska
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California
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Connecticut
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District of Columbia
Florida
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Hawaii
Idaho
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Tennessee
Texas
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Vermont
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Washington
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Wisconsin
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State
Zip Code
Phone
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Email
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How did you hear about Stephanie and/or Sacred Paws?
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Companion's/Companions' Information
Name
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What species is your pet?
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Canine
Feline
Equine
Porcine
Bovine
Other
Sex
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Male
Female
What is your pet's current age OR age of when he/she crossed the Rainbow Bridge?
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What days and times work best for you to schedule a session? (Monday-Friday 12-7pm)
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Declaration of Rights
Client Declaration: ARTICLE IX, US CONSTITUTION “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the People”. Under the Ninth Amendment to the Constitution of the United States of America, I retain the right to health care (or psychological, educational, and other services). This includes the right to choices in food consumption, obtaining and purchase of any therapy, regimen, modality, remedy, or product recommendation by the practitioner, doctor, therapist, or other professional of my choosing. The enumeration in this declaration of these rights shall not be construed to deny or disparage other rights retained by me, or my right to amend this declaration at any time. Notice is hereby given to any man, woman, or person who receives a copy of this Declaration and who, acting under the color of the law, intentionally interferes with the free exercise of the rights retained by me under the Ninth Amendment, as enumerated in the Declaration, that they may be in violation of my civil and constitutional rights, Title 42, U.S.C. 1983 et seq and Title 18, Section 241.
Policies & Procedures
Services Offered: energetic, behavioral, and natural health assessment, evaluation plans, plans of action, recommendations for nutrition, herbal, homeopathic and other holistic health considerations. Initial Visits: 15-90 minutes. Follow-up Visits: 15-60 minutes Office Hours: Monday-Friday 12-7pm (closed on all Saturdays, Sundays, and major holidays) Products: products can be obtained through respective resources shared during session. Products are not carried in house at this time. Privacy: all records are private and will only be released if required by law. Donations: donations are due before consultation, session, course, seminar, etc. Donations accepted in forms of credit card, check or cash. Processing fees for credit cards are applied. For email support post session, a separate donation would be incurred (unless the response is quick (under a few minutes). Cancellation: all cancellations received prior to 48 hours of appointment, will receive full refund. All cancellations before 48 hours will result in 50% refund. Termination: The client or practitioner may terminate this agreement at any time. Emergencies: Sacred Paws does not provide any emergency services. In the event of an emergency is occurring for your animal, contact the nearest emergency animal hospital in your location. If you suspect your pet has come in contact with or ingested something poisonous, contact ASPCA Animal Poison Control Center right away at 1-888-426-4435 or Pet Poison Control Center at 1-800-213-6680.
By typing my name below, I understand fully and accept the aforementioned (my Constitutional rights, the policies, the procedures).
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Consent
I, the pet parent, as typed above, request the services of Dr. Stephanie Smith (herein referred to as Stephanie), to perform spiritual, energetic, natural health, nutritional, herbal, homeopathic, behavioral and other holistic health assessments of my animal(s), followed by recommendations for which are intended to help reduce my animal’s/animals’ stress, enhance overall health, improve wellbeing, or otherwise provide information from my animal who has crossed over (passed away). I understand that I am and have full responsibility of my animal’s/animals’ health and wellbeing. The information Stephanie provides is for educational purposes only. What I do with this information is for me to decide and to discuss with my animal’s/animals’ veterinary medical and support team.
Disclosure
I understand that Stephanie completed her Doctor of Animal Naturopathy (DAN) program at Kingdom College of Natural Health and graduated in 2025. Stephanie has obtained many degrees, certifications, and engaged in many courses of study over the decades. Some of which include a Master’s of Art in Health Education, Bachelor of Science in Movement Science, Certified Dog Behavior Consultant (CDBC), Certified Professional Canine Nutritionist, Animal Communicator Mentorship program, Certified Reiki Practitioner, Certified Health Coach, Canine Herbalist, Acute Animal Homeopathy, Certified Dog Trainer and much more. Stephanie has nearly two decades experience in holistic health overall and close to five years of professional experience with canine and animal natural health and behavior.
Disclaimer
I understand that Stephanie is not a licensed medical professional and therefore does not diagnose, prescribe, treat, or cure for any disease, mental, physical, or behavioral and any recommendations made are to be discussed with my [holistic] veterinarian or other licensed medical professional of my choosing. I understand that donations are due in full prior to the booking of consultations, sessions, seminars, workshops, and other services offered. All appointments require a 48-hour notice of cancellation for full refund. A 50% refund will be given for appointments cancelled within the 48 hours timeframe.
By typing my name below, I understand and accept the aforementioned (the consent, the disclosure, and the disclaimer).
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By typing my name below, I enter into this agreement willfully and without reservation.
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