Wellness Exam Questionnaire

Format: (000) 000-0000.

If date of birth is unknown, please provide best estimate.

Please upload any medical documents you may.

Laproscopic spays for females may be an option. Please ask your veterinarian for more details.

Dogs that have deep chests are at greater risk for a life threatening condition, called Gastric Dilatation Vovulus, or "bloat".

A procedure, called a gastropexy, may help decrease this condition in your pet. This can be done laproscopically, and often done at the same time as your pet's spay or neuter.

Please be as specific as possible. List the name of each medication and its strength, as well as how frequently your pet takes it.

Be specific as possible. When does your pet cough? What does the cough sound like? Is the cough productive? How long has your pet been coughing?

Be specific as possible. When does your pet sneeze? Is there any discharge with the sneeze? If so, what color is the discharge? How long has your pet been coughing?

Be specific as possible. When does your pet vomit? What does the vomit look like? How frequently does your pet vomit? How long has your pet been vomiting?

Be specific as possible. When are your pet's allergies the worst? What symptoms does your pet exhibit? How long has your pet been exhibiting these symptoms? Have you used any treatments or medication to help with allergies in the past? If so, what, and did it help?

1 is Not itchy, 10 is Severe

1 is Not Painful, 10 is Very Painful

Bordetella and Canine Influenza vaccinations are recommended if your puppy/dog is going to be participating in these activities.

These activities increase your pet's exposure to ticks. We recommend using tick prevention and vaccinating for Lyme Disease.

If your puppy is still growing, it is recommended to purchase prevention monthly to ensure the correct dosing.

Thank you for allowing us to care for your pet. We are looking forward to seeing you at your appointment.

If your kittenis still growing, it is recommended to purchase prevention monthly to ensure the correct dosing.

If your kitten is still growing, it is recommended to purchase prevention monthly to ensure the correct dosing.

Thank you for allowing us to care for your pet. We are looking forward to seeing you at your appointment.