PetInfo

PET INFORMATION
Pet's Name:
Owner Name: First Name * Last Name *
Date of Birth/Approximate Age:
Species:*
Breed:
Color/Markings:
Sex:

FemaleSpayed FemaleMaleNeutered Male
Where and when did pet come to be in your family?:
Are there other pets in your household?:

YesNo
If so, please indicate quantity:

Dogs: # Cats: #

Birds: # Reptiles:#
Other:
Please indicate quantity.
Are they doing well?:

YesNo
Are they up to date on preventative care?:

YesNo
Would you like to add your other pets to our files?:

YesNo
Reason for today's visit?:
Tell us why you're visiting us today:
We are Fear Free Certified and want to make this visit as easy as possible for all pets.
Is your pet fearful, anxious, or aggressive during veterinary visits?:
Would you be interested in doing an initial Fear Free Examination for your pet's first visit instead, Yes or No?:
This allows your pet to have a happy first impression without any procedures it may be anxious about. It also allows our doctor to determine if herbal or medicinal help is warranted to give your pet prior to next the wellness visit in which procedures will be done.

Please call us within 48 hours of your appointment time if you would like to do a Fear Free Visit, or if you would like more details.
How is your pet doing? (Please check all that apply)
Energy Level:

NormalGoodPoor
Current Appetite:

NormalGoodPoorDecreasedIncreased
Drinking:

NormalIncreasedDecreased
Urination:

NormalIncreasedDecreased
Bowel Movements:

NormalIncreasedDecreasedDiarrheaColor ChangeOther
Has your pet been...?:

VomitingCoughingLimpingSneezingSeizuresDischarge from eyesDischarge from noseNONE
If so, please describe:
Skin Problems...?:

Sores/ScabsRednessScalyFlakyOdorItchingChewingHair LossLumps/BumpsNONE
If so, location:
Ear Problems...?:

ItchingRednessDischargeHead TiltPawing/ShakingOdorNONE
Other Behavior Problems...?:

House SoilingInappropriate ChewingExcessive BarkingDestructiveAggressionFearful at HomeNONEOther
Tell us about your pet's activities
How much time does your pet spend outdoors, other than to relieve themselves if canine?:

100%75%50%25%0%
What plant(s) does your pet have access to? This is important to know because some can be toxic to your pet.
Ex: Sago Palms, Palm Trees, Lilies, etc..
Does your pet get professionally groomed?:

YesNo
Does your pet board in a kennel facility?:

YesNo
Nutrition
What kind of food do you feed your pet?
Please specify brand/types and how often of each:

DRY BRAND
Brand/Protein(s): name   How often/much:   cups / ounces

CANNED BRAND
Brand/Protein(s): name   How often/much:  can size / portion

RAW BRAND
Brand/Protein(s): name   How often/much:  ounces / pounds

TREATS
Brand/Protein(s): name   How often/much: amount per day
People food? How often? (Please specify):
Animal Bones? How often? (Please specify type such a raw meaty bones):
Current or Previous Medical Conditions
Does your pet have any allergies/sensitivities to food, medications, vaccines, etc?:

YesNo
If Yes, please describe:
Has your pet had any surgeries or anesthesia procedures?:

YesNo
If Yes, Please describe:
Did your pet have any problems/complications with anesthesia?:

YesNo
If Yes, Please describe:
Medications

List all medications, suppliments, and herbals your pet is currently receiving (name and dosage).
Brand/Type: name Dose/amount per day: amount .
Brand/Type: name Dose/amount per day: amount .
Brand/Type: name Dose/amount per day: amount .
Brand/Type: name Dose/amount per day: amount .
Additional Medication Info:
Vaccination and Medical History
Hospital/Clinic Name: name* Phone: number* .

Email: Email
*Many Hospitals/Clinics require owner release of pet medical records.
Heartworm Preventative
Is your pet currently taking heartworm preventative?:

YesNoPet has NEVER been on heartworm prevention.
If Yes, what brand?: blanks . Date given: blank .
If No, what brand?: blanks . Approximate last date given: blank .
Flea/Tick Control Products
Have you seen any fleas or ticks?:

YesNo
Flea/Tick control products used?: Name . Date given: MM/DD/YYYY .
In Home?: Name . Date treated: MM/DD/YYYY .
In Yard?: Name . Date treated: MM/DD/YYYY .
Dental Care
Do you brush your pet's teeth?:

YesNo
Other dental care methods?:
Date of last dental cleaning:

MonthDayYear
Identification
Does your pet have a name tag?:

YesNo
Microchip Identification?:

YesNo
We believe in all pets being microchipped. Would you like more information on this?:

YesNo
Pet Insurance
Is your pet covered under any Pet Insurance?:

YesNo
If yes, what is the name of your Pet Insurance Provider?:
If no, would you like information on Veterinary Pet Insurance?:

YesNo
Is there anything else you would like to mention or have concerns about today?
We gladly provide a written Health Care Plan with associated professional fees. This will be important to you since ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. In cases of extensive medical or surgical procedures, when full payment may be difficult at discharge, we accept Visa, American Express, Discover, or Care Credit.
Thank You for being a valued client with Fur & Feather!

We are updating our Cancellation Policy

as follows:

As of May 1, 2024, all appointments with the Doctor will require a Scheduling Fee.

Scheduling Fees are non-refundable for cancellations made within 24hrs of the scheduled appointment time.

Cancellations made prior to the 24hr window may have a partial refund returned to the card used to make the payment (minus $14 Processing Fee).

***The full Scheduling Fee amount may be utilized as a Credit on Account for future services.

We appreciate your understanding as we strive to provide excellent service to our patients in need!
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PET INFORMATION