MEDICAL HISTORY: Oncology Recheck

Medical History: Oncology Recheck

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During the COVID-19 outbreak, the health and safety of our clients, patients, employees, doctors and our community is paramount. As such, we are required by the College of Veterinarians of British Columbia to take additional precautions in providing care to patients from at-risk or COVID-positive households.
Are you, someone in your household, or someone with close contact with your pet either COVID-positive or experiencing any symptoms of COVID-19 (including sore throat, cough, fever, or difficulty breathing)? *

Yes No
Your name *
Your email
Optional: If you enter in your email, we will send you a copy of this form to you.
Your pet's name *
Phone number where you can be reached today
(XXX) XXX-XXXX
Approximate time of pick-up (if you are dropping off)?
e.g. 4pm
Is there anything you would like to discuss with the oncologist today? Please note the oncologist will speak to you prior to treatment if there are any abnormalities on bloodwork or physical exam. *

Yes, prior to treatment Yes, at time of discharge No
Since your last visit...
Is your pet having difficulty breathing? *

Yes No
Has your pet’s appetite changed ? *

Yes No
How would you describe this change in appetite?

Increased appetite and/or thirst Mildly decreased or needed coaxing to eat Moderately decreased (3 days or less) Very decreased (3 days or more) Not eating, needed medical care
Has your pet had any vomiting? *

Yes No
How severe is the vomiting?

Mild: 1-2 episodes, only one day Moderate: 8 or fewer episodes, two days or less Significant: many episodes over several days, needed care Severe: required hospitalization
If medications were given for vomiting, what medications and which days?
Has your pet’s energy level or attitude changed? *

Yes No
How would you describe this change?

Improved Mild lethargy or decreased activity Lethargic for 3 or more days Very lethargic, needed care Severe lethargy, required hospitalization
Has your pet had diarrhea? *

Yes No
How would you describe the diarrhea?

Mild: soft stools, no increased frequency Mild: soft stools with increased frequency or urgency Moderate: 3-5 episodes, needed medications Significant: many episodes overseveral days, needed care Severe: required hospitalization
If medications were given for diarrhea, what medications and which days?
Is your pet coughing? *

Yes No
When did it start?
How often does it occur?
Has the coughing gotten better, worse, the same?

Better Worse Same
Is your pet sneezing? *

Yes No
When did it start?
How often does it occur?
Has the sneezing gotten better, worse, the same?

Better Worse Same
Is there nasal discharge?

Yes No
How would you characterize the discharge?
e.g. clear, green, bloody
Do you think your pet is in pain? *

Yes No
Where is the pain?
Is your pet drinking normally? *

Yes No
Are they drinking more or less?

More Less
Is your pet urinating normally? *

Yes No
Are they urinating more or less?

More Less
Is there blood in the urine?
Is your pet eating normally? *

Yes No
Are they eating more, less or not at all?

More Less Not at all
How long have they not been eating?
Has labwork or any other test been performed elsewhere since your last visit to Oncology? *

Yes No
Please list here:
Please list any medications your pet is taking (including non-prescription and supplements). Include name, strength (mg), how often, for how long. *
e.g. 'prednisone 5 mg tabs,½ tab once daily for 3 months' or N/A
Do you need refills of any medications? *

Yes No
Which ones?
OPTIONAL: HOW DID YOU FIND US?
We'd like to understand the specifics of how you discovered us during your time of emergency.
e.g. I searched Google for 24 hour emergency vet; My vet recommends you for emergencies, etc
Feedback on this form? Send your thoughts to marketing@bbvsh.com
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Medical History: Oncology Recheck

Since your last visit...