Dog / Cat Medical History
Your Full Name
What is the date of your appointment?
Who is your pet's appointment with?
Dr. Tom Frankmann
Dr. Jessica DeMarco
Dr. Carolyn Askew
I am not sure
Your Pet's Name
Please confirm your email address
Cell Phone Number
Please select your pet's reason for visiting us:
Wellness Visit/Vaccines/Preventative Care
Is your pet experiencing any of the following (check as many as apply):
Weight Loss or Trouble Eating
Vomiting or Diarrhea
Lameness or Difficulty Moving Around
Not Experiencing Any Known Medical Concerns
Please describe further any other concerns you would like the doctor to know about. If no concerns, type n/c.
Does your pet typically like or dislike his/her visit with us?
Loves coming in!
Hesitant but ok.
Hates the car ride more.
Experiences mild signs of anxiety.
Experiences moderate signs of anxiety.
Typically needs sedation.
Is your pet currently taking any medication? Please also include any Supplements, Heartworm/Flea/Tick medications.
If so, please list the medications he/she is taking. Include dosing information (how much/how often).
When was the last dose of Heartworm and Flea/Tick Prevention given?
Do you require any refills? We recommend that you double check before your appointment.
What BRAND of food does your pet eat? Please be specific.
What type of food does your pet eat?
Dry food only
Canned food only
Both canned and dry food
How many times a day do you feed your pet?
How much does your pet eat at each feeding? Please be specific (cups, cans, etc.)
What additional treats, snacks, or human food does your pet receive. Please be specific and indicate frequency.
Has your pet's environment changed at all? This includes the addition of new pets, boarding/grooming/training, travel, etc.
What is your pet's primary environment?
Spends time both indoors and outdoors
To make your pet's visit more positive, we offer food rewards such as treats, canned food or cheese, and peanut butter. Please select from the following:
No concerns, go ahead!
I will bring my pet's favorite treats along
My pet has food allergies
My pet is coming in for gastrointestinal issues
Avoid Peanut Butter d/t allergy in household
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