Idea Generator for a Wellness Baseline Name:__________ Date_ For humans, dogs, horses, birds, cats, Iguanas, turtles, fish, and more (but mostly

AHermanDogTherapist.com 831.624.8000 revised 3/2014

Idea Generator for a

Wellness Baseline Name:______________ Date_____

For humans, dogs, horses, birds, cats, Iguanas, turtles, fish, and more

(but mostly for humans and dogs)


PHYSICALdescribe or rate, as you see fit

• Movement• Structure (conformation/bone structure, etc.)• Breathing• Digestive• Skin • Hair/fur/feathers/scales• Sensory

– Sight– Taste– Touch – Hearing– Smell

• Any known issues/conditions


BEHAVIORAL• Energy level (1=zero energy, 3= nice, even,

5=super hyper)

• Interactiveness scale (1=not at all, 3=ideal5=won’t leave others alone)– With other members of the family– With same species strangers– With different species strangers– Other notes

• Hours of sleep/day– At night– Naps

• Play scale (and what is play according to your definition?)(1=refuses to play, 3=plays nicely/appropriately, 5=non-stop insistence on play with

everyone)


Emotional

• Happiness Scale (1=very unhappy, depressed3=evenly, moderately happy, 5=off the charts, ecstatic all the time!)

• Separation anxiety (yes, sometimes, no)

• Fearfulness (Of what situations? What people?)

• Protectiveness (In what situations? Of what and/or whom?)

• Other emotions you wish to keep track of


COGNITIVE• Comprehension level (1=no understanding of what you are asking for,

3=okay understanding, 5=extraordinary understanding)

• Outgoing communications– By voice, body movements, eyes, etc. and note which are utilized the most– ESP or communications not explained above

• Communications with same species (rate receptive and expressive, quality, and comprehension levels)

• Communications with other species (rate receptive and expressive, quality and comprehension levels)


Intake/Output

• Foods typically eaten (list and incl. quantities, times of day, appetite level)

• Supplements (list)

• Water (type, quantities, times of day, level of thirst)

• Output (stool, consistency, frequency)

• Output (urine, color, quantity, frequency)


Exercise and Typical Day

• Type of exercise, time spent each day

• Stamina/Energy level (1=none, 3=moderate, 5=high)

• Describe a typical day for whoever’s baseline this is including time spent alone


OTHER OBSERVATIONS(include social skills if not covered elsewhere, sense of spirituality if appropriate, plus any idiosyncracies, foods liked or disliked, etc….anything that explains or describes this being which hasn’t already been recorded)


One or moreGoals

for Improved Balance(Try just one or two!!! Make a short term goal and a long term goal in any category you wish to work on. Set dates to achieve goals. You can always push these ahead or add a new goal if one has been met. Be as specific as possible, make measureable goals, make them as realistic and timely as possible, and again, MOST IMPORTANT, just one or two which ARE ACHIEVEABLE!!!

• Physical• Behavioral• Emotional• Cognitive• Input/Output• Exercise/Typical Day• Social• Other

Documents

Idea Generator for a Wellness Baseline Name:______________ Date_____ For humans, dogs, horses, birds, cats, Iguanas, turtles, fish, and more (but mostly

Idea Generator for a Wellness Baseline Name:__________ Date_ For humans, dogs, horses, birds, cats, Iguanas, turtles, fish, and more (but mostly