*** THIS FORM IS FOR EXISTING APPOINTMENTS ONLY ***
 

    • • • CLIENT INFORMATION • • •

    Please fill out this form for existing appointments only. (*required)




    Required only for curbside (not needed if you are coming inside):


    • • • VISIT INFORMATION • • •


    YesNo


    "*IMPORTANT* Please be specific about the brand, flavor/protein, amount fed per day. Our doctors need this information to make appropriate diet/weight recommendations for your pet.



    YesNo

    If yes, please tell us the brand and type of parasite prevention.

    We recommend year-round heartworm prevention (12 months) with Heartgard. We recommend Nexgard (oral) or Frontline Gold (topical) for flea and tick prevention, offered in 6 or 12 packs.

    Participates in dog shows/agility/other group activitiesVisits groomers regularlyBoarded recentlyVisits doggy daycare/dog parksTravels to rural areas (e.g., cabin, camping)Travels outside MinnesotaRegularly exposed to new pets (i.e., fosters)Hunts and/or eats preyIs outdoors unsupervisedLives exclusively indoorsLives exclusively outdoorsOther


    Wellness/vaccinesMedical concern





    YesNo


    When did the diarrhea start?
    Has there been recent changes to food or treats, or has your pet gotten into something (garbage, toys, etc.)?
    What color is your pet's stool?
    Any blood or mucous?


    YesNo


    Could your pet have eaten or chewed up something toxic or possibly dangerous (clothing, toys, etc.)?
    What does the vomit look like?
    When did the vomiting start?
    Any recent changes to food or treats?


    YesNo

    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?


    YesNo


    When did it start?
    Is it better, worse, or staying the same?
    Is it better after rest?
    Is it worse after exercise?
    Which leg is your pet limping on?
    Does it seem to shift from one leg to another?
    Was it preceded by any known injury or trauma?


    YesNo

    If yes, please explain the signs of skin/ear issues you have noticed in your pet.


    YesNo

    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?


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    1. Masks are required when entering the clinic building.
    2. Pets must be on leash with secure collar or in a carrier.