Pet Exam Form

Your name

Your pet's name

Phone Number - where you can be reached TODAY

Email address

About Today's Visit

Tell us what brings you in today. How long has this been going on?

Does your pet have any lumps or bumps? If so, how long have they been there and are they changing?

Do you perceive that your pet has any pain or arthritis?

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

Eating Habits

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

What brands of food do you feed your pet?

What treats and chew toys do you give?

Any recent dietary indiscretions such as eating trash or objects?

Any changes in thirst, frequent urinations or accidents?

Medications

What heartworm medicine do you use?

What flea preventative do you use?

Any other current medications / supplements? Please include dosage and the time the med is given.

Did your pet receive meds today? If so, what time?

Do you prefer a holistic approach?

Is your pet difficult or easy to medicate?

General info

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

Any behavioral issues?

Anything else you wish to discuss?

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