Canine Wellness Appt. Questions

We look forward to seeing you and your pet at their upcoming wellness visit! Please take a moment to answer the following questions to expedite your check in process. Thank you so much for allowing us to care for you best friend!

*For the comfort and convenience of your pet, please remember to bring a stool sample. Thank you!

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Pet's Name*

Does this pet have insurance?

YesNo

What kind of HW/Flea Prevention are you currently using?

SentinelTrifexisProheartOther

Any Missed Doses?

YesNo

Do you need any refills of your HW and/or Flea Preventatives today?

YesNo

Would you like your pet microchipped today?

YesNo

Would you like your pet to receive the canine influenza vaccine? Recommended for dogs that go to daycare, boarding, grooming or have frequent social interactions with other dogs. (upper respiratory infection)

YesNo

What does your pet eat at home?

How is their appetite?

What medications are they currently on?

Has there been any change in their water consumption? Are they drinking any more or less than usual?

Has there been any change in their level of activity?

Have you noticed any vomiting or diarrhea?

Would like us to perform early detection screening bloodwork? This is a basic Chemistry panel that checks organ function (liver, kidney enzymes, electrolytes) and Complete Blood Count panel that checks red blood cell count, white blood cell count, platelet count, etc...*Additional cost of $61.81

YesNo

Comments?

Please verify that you are human*