Pet Exam Form

Your Name And Your Pet's Name*

Phone Number - where you can be reached TODAY*

Your Email Address*

About Today's Visit*

Tell us what brings you in today. How long has this been going on? If this is a recheck: Are things better, worse or the same since you were last here? What is working? What isn’t working? The more details you give us the better we can help! Also, if this is a recheck, simply fill out the subsequent questions that have changed since your last visit and you may skip the rest.

What is your pet’s lifestyle? Does your pet board or go to doggie daycare or the groomer? Does your pet travel up north or into wooded areas? Is your dog a city slicker or a rugged outdoorsman? Does your cat go outside to roam the hood or stay indoor or in a screen enclosure? We vaccinate pets based on their lifestyle.*

Do you perceive that your pet has any pain or arthritis? We have new treatment modalities that are cutting edge for arthritic pets, especially cats.*

Has your pet had any recent vaccinations or lab work or exams at another pet ER or vet?*

Eating Habits

Any recent changes in food, appetite, vomiting or diarrhea?*

What brand/s of food and treats do you feed your pet?*

Medications

If this is a long standing dermatology or ear issue, we have a dermatology form that you may print out and bring with you under "forms". The more details you provide the better!

Do you need any refills on medications?

What medications have been useful? What medications did not work in the past? Has your pet had any adverse reactions to medications or vaccines?

Is your pet easy to medicate or difficult to medicate?

What heartworm medicine do you use?*

What flea preventative do you use?*

Any other current medications/supplements? PLEASE INCLUDE DOSAGE AND FREQUENCY the meds or supplements are given. Even if you get the medication from our clinic you’d be amazed how often clients change the dosage and frequency without telling us.*

Other

If you are new to our clinic, we can contact your prior vet for prior records so that we don’t repeat or duplicate treatments. If you tell us who your prior veterinarian is we can make that call for you. We simply ask for records on a mutual patient. Would you like us to call? If so, please list your prior veterinarian’s name and phone number.

Do you prefer a holistic approach?

Any change in thirst or urination? Any coughing or sneezing? Any lethargy?

General Info

Does your pet have a microchip? We offer them free, would you like one?

Any behavioral issues? If so, please give us details. We have a behavior questionnaire also on this website under forms that you can print out and bring with you.

Anything else you wish to discuss? Don’t be shy.

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