Canine Health History Latham Animal Hospital

Canine health history
Date
Pet's name
Your last name
Phone Number

Area CodePhone Number
Client health screening: please complete this survey prior to coming to our hospitals to inform us of any risk to our team members. We do require face coverings for all clients coming within six feet of our employees.
Please check all that apply so we may take appropriate precautions.
Health Survey:
Let's start with their mouth:
What about your dog's mouth? (check all that apply)
And their eyes:
My dog's eyes (check all that apply)
Ears:
My dog's ears (check all that apply):
Heart and Lungs:
My dog (check all that apply)
Skin and Body:
My dog's coat and body (check all that apply)
Mobility and movement:
My dog(check all that apply)
Weight and appetite:
My dog (check all that apply)
GI system:
My dog (check all that apply)
Behavior and Nutrition:
My dog is
My dog (check all that apply)
For primary nutrition, my dog eats (check all that apply):
For treats, I use (check all that apply)
For fleas and ticks, I use
For heartworm prevention, my dog
Does your dog have any special environmental risks that we should know about?
My primary concern today is:
Are there any other questions that you would like us to address at your visit?
Thank you so much for completing this survey. We appreciate your deep knowledge of your pet, and this helps us partner more effectively with you to develop the best preventive care plan tailored to meet your pet's and your family's needs.
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Canine health history