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Friday: 8 am - 4 pm
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Pre-Visit Questionnaire
Client Name
Pet's Name
Immediate Contact Number
Phone Number
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- None -
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What is the reason for this visit? (Please check all that apply and explain in more detail if prompted)
Personalized Wellness Care (physical examination, vaccinations, preventative medicine and diagnostics)
Medical Concern (skin, vomiting/diarrhea, lump, stiffness/lame, pain, oral health, inappropriate elimination, weight loss, other condition)
Behavioral Concern (anxiety, fear, inappropriate elimination, chewing, aggression, barking)
Follow-up Appointment
Other
Please provide further information:
Is your pet currently on prescription medication or supplements?
Yes
No
If yes, please list all medications and supplements here.
Diet - Please describe everything your pet eats as thoroughly as possible including food brand, amount, treats, and special things like people food.
At home dental care - Please describe your pet's dental care regimen (eg. brushing, dental chews, food/water additives. How often is dental care performed?
Are there any other pets in your home? (Please list all species)
Do you travel with your pet either within the United States or Internationally? If so, where?
If yes, please also include method of travel (eg. airplane, train, car, etc.)
Is there anything that makes your pet nervous or anxious?
Yes
No
If yes, please explain here.
Any additional information you would like our doctors and team to know about your pet (allergies or previous reactions to medications)?
May we share your pet's photo or video on Instagram/Facebook/Website?
Yes
No
If your pet has their own social media accounts can you please list them so that we can tag and follow?
