AHI Cares - Pre-Visit Form
What is the Date of your pet's appointment?
What is the time of your pet's appointment?
What doctor is your pet seeing?
I'm not sure
Please enter a valid phone number.
Your Pet's Name
Has your pet experienced any recent vomiting and/or diarrhea?
If Yes, please describe when, how often, and consistency
How are your pet's drinking habits?
Drinking normal amounts of water
Noticed an increase in drinking
Noticed a decrease in drinking
How are your pet's urinations?
Urinating a normal amount/no foul odor or discoloration noted
Noticed an increase in urinations
Noticed a decrease in urinations
Straining to urinate
Noticed a foul odor or discoloration
What food are you currently feeding? (Name Brand)
Is it a Grain Free Diet?
How much do you feed and how often?
i.e: 1 cup twice daily
How is your pet's appetite?
Good, no changes or concerns
Noticed decrease in appetite
Noticed increase in appetite
Example for above section
i.e: Apoquel 16mg 1 tablet once daily
Please list the heartworm AND flea/tick medications you are currently giving. If none write 'none.'
Please list any refills with amounts that are needed
Please note anything additional you would like the doctor to be aware of today. For example: excessive itchiness, lethargy, etc.
Should be Empty: