Email *
Phone *
Pet's Name *
Pet's Breed *
How is the potty training / litter box training going?
Is your pet having issues with their hearing, vision, or movement? If yes, please explain.
Has there been a change in diet? What food is being fed and how much/frequency?
If yes, please list all preventive medications.
If yes, please list all supplements and medications.
Reason for upcoming visit:
Please list all medical conditions here.
Please list all additional cats, dogs, and other pets.
Is the initial problem better, worse, or the same?
Are you able to give the medication(s) as prescribed?
Are you finished with the meds?
Any change in appetite or drinking habits during medicating?
Any vomiting or diarrhea while on the medication?
Is it a productive cough, and if yes, what does the pet cough up?
Has your pet been recently boarded or around other/new pets?
Is there a time of day or situation when the cough is more prominent?
Does there seem to be any pain (ie squinting)?
Is the pet rubbing at eye(s) a lot?
Any other pets or people affected in the house?
Is there a known trauma?
Have you tried any medications at home already?
Are the ears painful?
Do you clean the ears on a regular basis?
Is the pet scratching or shaking its head at lot?
Have you tried any medications at home?
Does your pet have a recent history of swimming, bathing, or a moist environment?
Please describe (bloody, mucoid, watery, amount, normal color but different consistency):
What do you normally feed? Amt and freq?
Have there been any recent changes in their diet?
Did you recently open a new bag of food?
Did you recently purchase a new type of treat/rawhide/bone?
Have you tried a bland diet?
Is there any history of eating garbage, table food, toys?
Has there been a change in environment, boarding or other stress?
If yes, please explain.
If yes, please explain.
Which leg(s) are affected? Is it a shifting leg lameness?
Has it been an acute and rapid onset?
Please describe your pet's change in sleeping behavior.
How long has your pet been having seizures?
How far apart are they?
Are there any obvious triggers? (i.e. storms, people, full moon, medications)
How long do they last?
Are they getting progressively worse (i.e. more violent)?
Have you tried any medication? Please list them here.
Are any of your pet's urination habits different (i.e. out of box, in house)
Does your pet have control over urination (or does it happen without them knowing it)?
Is there a particular time of day/night it occurs?
Is the pet vomiting food or phlegm/bile?
How long after eating does the pet vomit?
Is there any history of recently eating garbage/table scraps/toys/strings?
