We are a peanut-free zone.
To the best of your knowledge, do you feed your pet peanut containing products or treats? Yes No
Is it OK to give your pet clinic treats? (Please bring your own for us to use if not.) Yes No
What do you feed your pet?
What medications and supplements do you give your pet? Please include amount given.
Is your pet currently receiving parasite prevention? Yes No
If yes, please tell us the brand and type of parasite prevention.
Would you like preventatives refilled or prescribed today? Please choose: Heartgard Plus, Nexgard, Simparica Trio. We recommend year round (12 months) heartworm prevention with Heartgard or Simparica Trio (also a flea and tick preventative). Nexgard is also available for flea and tick prevention.
How is your pet’s appetite? —Please choose an option— normal increased diminished
Have you noticed any change in water consumption? —Please choose an option— more less no change
Have you noticed any diarrhea or changes in stool? Yes No
Have you noticed any vomiting? Yes No
Have you noticed any coughing/sneezing/discharge or other respiratory signs? Yes No
Please explain the respiratory signs you have noticed in your pet.For dogs: Any exposure to other dogs (ex: dog parks, day care, groomers, classes or playdates) in the last 2 weeks?For cats: Any exposure to new cats or recent changes in household or routine in the last 2 weeks?
Have you noticed any limping/pain/stiffness or other mobility issues? Yes No
Have you noticed any skin or ear issues, such as itching, head-shaking, chewing, or scooting? Yes No
If yes, please explain the signs of skin/ear issues you have noticed in your pet.
Have you noticed any new lumps or changes in existing lumps? Yes No
Please explain the character of the change of existing lumps, or when you noticed the new lump. Has the new lump changed since first noticed it?
Have you noticed any change in urination? Yes No
Please describe observed changes including when it began.
What is the main reason for your visit today? Wellness/vaccines Medical concern
Do you have any other questions or concerns you would like to discuss at today's visit? ( 860 characters left)
Please describe your primary medical concern. When did it start? Are signs improving or worsening? Have you given any treatment for it at home?
For this appointment, I understand that:
Pets must be on leash with secure collar or in a carrier.
Media consent:
I agree I decline
