Patient Physical Exam Questionnaire

  • Patient Physical Exam Questionnaire

  • Hello,

    Please provide the following information so we can expediate your pet(s) appointment.  Please fill out each question even if it does not pertain to your visit today and be as descriptive as possible. 

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  • What date is your appointment scheduled for?*
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  • 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?*
  • 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?*
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  • Our PAW Plans help manage your pet's preventive care and mitigates unexpected costs throughout all life stages. 

    If you'd like to read about the wellness plans we offer, please visit this link:


    Paw Plan Information

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