• Patient Physical Exam Questionnaire

  • Hello!

     

    Please provide the following information so we can expedite your pet’s appointment. Complete each question, even if it does not relate to today’s visit. Please provide as much detail as possible.

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  • What date is your appointment scheduled for?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Has your pet been examined elsewhere for this concern?*
  • Has your pet been coughing/gagging?*
  • Has your pet been sneezing?*
  • Has your pet had any recent vomiting?*
  • Has your pet had any recent diarrhea?*
  • Has your pet had any constipation?*
  • Has your pet had any trouble with urination?*
  • Select all that apply:
  • Is your pet drinking normally?*
  • Is your pet eating normally?*
  • Has your pet experienced any recent weight gain or weight loss?*
  • Does your pet have any skin issues? (Licking/scratching/chewing on the skin or feet)*
  • Select all that apply in terms of your pets skin:
  • Has your pet been scooting?*
  • Have you noticed any new lumps/bumps on your pet?*
  • Is your pet having any issues with their eyes?*
  • Select all that apply:
  • Is your pet having any issues with their ears?*
  • Select all that apply:
  • Does your pet have any issues with their mouth/teeth/gums?*
  • Select all that apply:
  • Does your pet have any trouble walking/running/jumping/getting up?*
  • Has your pet been lethargic?*
  • Have you noticed any behavior problems with your pet?*
  • Should be Empty: