mcclurevetclinic.com - Preventive Care Survey For Dogs

Preventive Care Survey for Dogs

Pre-visit survey for preventative care
Dog’s Name *
Your Name *

First NameLast Name
E-mail*
example@example.com
Phone Number *
Please enter a valid phone number.
Is your dog microchipped?*

YesNoUnsure
Please tell us about your dog’s diet*
Please tell us about any treats, dental chews, and human food your dog receives.
Your dog’s body condition is

OverweightIdealUnderweightUnsure
Which Heartworm prevention is your dog receiving? *

Interceptor PlusHeartgard PlusProheart6NoneOther
When was your dog’s last dose given? *
Which flea & tick prevention is your dog receiving*

BravectoNexgardCredelioNone
When was your dog’s last dose given?*
Please tell us about any other prescription, OTC medications, &/or supplements your pet is taking, including current dose and frequency.
Please check any of the following that apply: *

My dog lives with other animalsMy dog lives with childrenMy dog visits dog parksMy dog goes to grooming/boarding facilities
If your dog is having any mobility or comfort issues, please describe them here.
If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.
Should be Empty:

Preventive Care Survey for Dogs