Phone *
Secondary Phone
Email
What is your pet's social media account if you have one?
Whom shall we thank? *
If Other, please describe *
If Other, please explain *
Phone
Email
Patient's Name *
If Other, please describe *
Patient Age *
How long has the medical condition existed?
How frequently and for how long?
How frequently and for how long?
How frequently and for how long?
How frequently and for how long?
How frequently and for how long?
What flea/tick prevention do you use for your pet?
What heartworm preventative do you use for your pet?
What, if any, medications or supplements (over the counter or prescription) does your pet take or have applied routinely?
Please detail your pet's diet including brand of food, amount given, and frequency fed.
Where did you obtain your puppy (breeder, pet store, friend, shelter, rescue, humane society, other)?
How long have you had your puppy?
How old was your puppy when you obtained him/her?
Where does your puppy spend most of his/her day? (inside, outside, in a room, in a kennel, with you)?
Comments:
If you have other pets in the household, describe the puppy’s relationship with them.
Has your puppy ever shown any growling, barking, snarling or mouthing/biting towards you or anyone else? If so, when?
Are there things your puppy is afraid of or does not like? If so, please describe.
Has your puppy shown any of these signs: coughing, sneezing, itching, diarrhea, vomiting, or lack of appetite?
What brand of food do you feed your puppy? How much do you provide and how frequently? Is food available all the time or at set "meal times?" What treats do you offer?
Any change in water or food consumption?
What flea/tick prevention do you use for your pet?
What heartworm preventative do you use for your pet?
What, if any, medications or supplements (over the counter or prescription) does your puppy take or have applied routinely?
What are three things you enjoy about your puppy?
Do you have any concerns or topics you would like to discuss?
How long have you had your dog?
Where did you get your dog? (Ex: Breeder, Shelter, Stray, etc.)
Where does your dog spend most of his/her day? (inside, outside, in a room, in a kennel, with you)?
Comments:
If you have other pets in the household, describe the dog’s relationship with them.
Has your dog ever shown any growling, barking, snarling or mouthing/biting towards you or anyone else? If so, when?
Are there things your dog is afraid of or does not like? If so, please describe.
Has your dog shown any of these signs: coughing, sneezing, itching, diarrhea, vomiting, or lack of appetite?
Any change in grooming or sleeping habits?
Any change in water or food consumption?
What brand of food do you feed your dog? How much do you provide and how frequently? Is food available all the time or at set "meal times?" What treats do you offer?
What dental care (chews, brushing, cleanings) do you do with your dog?
Any change in frequency of urination or defecation?
Have you noticed any significant weight changes with your dog in recent months?
What flea/tick prevention do you use for your pet?
What heartworm preventative do you use for your pet?
What, if any, medications or supplements (over the counter or prescription) does your dog take or have applied routinely?
What are three things you enjoy about your dog?
Do you have any concerns or topics you would like to discuss?
Where did you obtain your kitten (breeder, pet store, friend, shelter, rescue, humane society, other)?
How long have you had your kitten?
How old was your kitten when you obtained him/her?
Where does your kitten spend most of his/her day? (inside, outside, in a room, in a kennel, with you)?
Comments:
How many litter boxes do you have and where are they located?
If you have other pets in the household, describe the kitten’s relationship with them.
Are there things your kitten is afraid of or does not like? If so, please describe.
Has your kitten shown any of these signs: coughing, sneezing, itching, diarrhea, vomiting, or lack of appetite?
Any change in water or food consumption?
What brand of food do you feed your kitten? How much do you provide and how frequently? Is food available all the time or at set "meal times?" What treats do you offer? Do you feed wet food, dry food, or both?
What flea/tick prevention do you use for your pet?
What heartworm preventative do you use for your pet?
What, if any, medications or supplements (over the counter or prescription) does your kitten take or have applied routinely?
Do you have any concerns or topics you would like to discuss?
How long have you had your cat?
Where did you get your cat? (Ex: Breeder, Shelter, Stray, etc.)
Where does your cat spend most of his/her day? (inside, outside, in a room, in a kennel, with you)?
Comments:
How many litter boxes are in the home and where are they located?
Any changes in activity, such as being more active at night, or sleeping more during the day? Any increase in vocalization?
Does your cat seem disoriented at times or unable to recognize familiar people?
Does your cat seem stiff when moving, slow to rise, or less agile?
If you have other pets in the household, describe the cat’s relationship with them.
Are there things your cat is afraid of or does not like? If so, please describe.
Has your cat shown any of these signs: coughing, sneezing, itching, diarrhea, vomiting, or lack of appetite?
Any change in grooming or sleeping habits?
Any change in water or food consumption?
What brand of food do you feed your cat? How much do you provide and how frequently? Is food available all the time or at set "meal times?" What treats do you offer? Do you feed wet food, dry food, or both?
Any change in frequency of urination or defecation?
Have you noticed any significant weight changes with your cat in recent months?
What flea/tick prevention do you use for your pet?
What heartworm preventative do you use for your pet?
What, if any, medications or supplements (over the counter or prescription) does your cat take or have applied routinely?
Do you have any concerns or topics you would like to discuss?
When and where did you acquire your exotic pet
How often is your pet handled?
If yes, how many and what type?
What type and size of enclosure/cage does your exotic pet live in?
What type of bedding/substrate do you use?
How often is the cage/enclosure cleaned?
What type of disinfectant do you use?
Type and Brand of food being offered?
How often?
Supplements?
How often?