Wellness/Annual Appointment

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Your Name* This field is required.
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Email* This field is required.
example@example.com
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Primary Contact Phone Number* This field is required.
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Your Pet's Name* This field is required.
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Approximate Age?
Under 1 year
1 to 6
6 to 10
Over 10
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Sex Status?Is your pet Spayed or Neutered?
Yes
No
Don't Know
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Species?
Canine
Canine
Feline
Other
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Breed?
Unknown
Mixed
Affenpinscher
Afghan Hound
Airedale Terrier
Akita
Alaskan Malamute
American Cocker Spaniel
American Eskimo Dog (Miniature)
American Eskimo Dog (Standard)
American Eskimo Dog (Toy)
American Foxhound
American Staffordshire Terrier
American Water Spaniel
Anatolian Shepherd
Australian Cattle Dog
Australian Shepherd
Australian Terrier
Basenji
Basset Hound
Beagle
Bearded Collie
Beauceron
Bedlington Terrier
Belgian Malinois
Belgian Sheepdog
Belgian Tervuren
Bernese Mountain Dog
Bichon Frise
Black and Tan Coonhound
Black Russian Terrier
Bloodhound
Border Collie
Border Terrier
Borzoi
Boston Terrier
Bouvier des Flandres
Boxer
Briard
Brittany
Brussels Griffon
Bull Terrier
Bulldog
Bullmastiff
Cairn Terrier
Canaan Dog
Cardigan Welsh Corgi
Cavalier King Charles Spaniel
Chesapeake Bay Retriever
Chihuahua
Chinese Crested Dog
Chinese Shar-Pei
Chow Chow
Clumber Spaniel
Collie
Curly-Coated Retriever
Dachshund (Miniature)
Dachshund (Standard)
Dalmatian
Dandie Dinmont Terrier
Doberman Pinscher
English Cocker Spaniel
English Foxhound
English Setter
English Springer Spaniel
English Toy Spaniel
Field Spaniel
Finnish Spitz
Flat-Coated Retriever
French Bulldog
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Wirehaired Pointer
Giant Schnauzer
Glen of Imaal Terrier
Golden Retriever
Gordon Setter
Great Dane
Great Pyrenees
Greater Swiss Mountain Dog
Greyhound
Harrier
Havanese
Ibizan Hound
Irish Setter
Irish Terrier
Irish Water Spaniel
Irish Wolfhound
Italian Greyhound
Japanese Chin
Keeshond
Kerry Blue Terrier
Komondor
Kuvasz
Labrador Retriever
Lakeland Terrier
Lhasa Apso
Lowchen
Maltese
Manchester Terrier (Standard)
Manchester Terrier (Toy)
Mastiff
Miniature Bull Terrier
Miniature Pinscher
Miniature Schnauzer
Neapolitan Mastiff
Newfoundland
Norfolk Terrier
Norwegian Elkhound
Norwich Terrier
Nova Scotia Duck Tolling Retriever
Old English Sheepdog
Otterhound
Papillon
Parson Russell Terrier
Pekingese
Pembroke Welsh Corgi
Petit Basset Griffon Vendeen
Pharaoh Hound
Plott
Pointer
Polish Lowland Sheepdog
Pomeranian
Poodle (Miniature)
Poodle (Standard)
Poodle (Toy)
Portuguese Water Dog
Pug
Puli
Redbone Coonhound
Rhodesian Ridgeback
Rottweiler
Saint Bernard
Saluki (or Gazelle Hound)
Samoyed
Schipperke
Scottish Deerhound
Scottish Terrier
Sealyham Terrier
Shetland Sheepdog
Shiba Inu
Shih Tzu
Siberian Husky
Silky Terrier
Skye Terrier
Smooth Fox Terrier
Soft Coated Wheaten Terrier
Spinone Italiano
Staffordshire Bull Terrier
Standard Schnauzer
Sussex Spaniel
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Toy Fox Terrier
Vizsla
Weimaraner
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier
Whippet
Wire Fox Terrier
Wirehaired Pointing Griffon
Yorkshire Terrier
Unknown
Mixed
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Recent Vaccines?Estimated vaccines given in the past three years. Proof of Rabies vaccine is Mandatory
Rabies
Lyme
Distemper
Bordetella
Lepto
Influenza
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Pet Family Lifestyle?Please help us to understand who your Pet hangs out with:
Travels with the family to the beach or mountains
Around young children in the home
Around Immunocompromised individuals or elderly
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Around other dogs?Please help us to understand your pet's Lifestyle with other dogs
Goes to a groomer or a boarding facility
Goes to obedience classes or dog shows
Owner travels frequently and sometimes on short notice
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Around Wildlife?Please help us to understand your pet's Lifestyle with Wildlife:
Goes outside to urinate and defecate
Goes hunting, camping, or to parks
Has a yard with wildlife traffic (mice, rats, skunks, possums, raccoons, or squirrels)
Has the opportunity to drink from, swim in, or stand in water outdoors (lakes, streams, ponds)
Lives in a rural area or a new housing development (built in the past 10 years)
Lives near or visits wooded areas
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Deer exposure?Please help us to understand your pet's contact with local Deer
Has a high number of ticks in the local environment
Goes hunting, camping, to parks or wooded areas
Deer pass through or near your yard
Do you use a tick control product?
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Dogfood Brand(s)?What Brand of Food is your pet on?
4Health
777 Dog Food (Dry)
Abound
Abound Original Formula Review
Acana
Acana Heritage Formula Review
Addiction Dog Food
Addiction Classic Formulas Review
Adirondack Dog Food (Dry)
Against the Grain Dog Food (Canned)
Alpo
Alpo Prime Formula Review
Alpo Chop House Formula Review
American Journey
American Natural Premium
Ancestry Dog Food (Dry)
Annamaet
Answers Detailed Dog Food (Raw Frozen)
Apex Dog Food (Dry)
Applaws Grain Free (Canned)
Artemis
Atta Boy! Dog Food (Dry)
Aunt Jeni’s Home Made (Raw Frozen)
Authority
AvoDerm
Azmira
BARF Dog Food (Raw Frozen)
Beaverdam Dog Food (Dry)
Ben’s Best Dog Food (Dry)
Bench and Field Dog Food (Dry)
Beneful
Berkley and Jensen Dog Food (Dry)
Big Red Dog Food (Dry)
Bil-Jac
Bixbi Rawbble Dog Food (Freeze-Dried)
Black Gold
Blackwood
Blue Buffalo
Blue Buffalo Life Protection Formula Review
Blue Buffalo Freedom Formula Review
Blue Buffalo Basics Formula Review
Blue Buffalo Wilderness Formula Review
Blue Buffalo Homestyle Recipes Review
Blue Buffalo Blue’s Stew Review
Blue Buffalo Divine Delights Formula Review
Blue Buffalo Natural Veterinary Diet Review
Blue Buffalo Earth’s Essentials Formula Review
Blue Buffalo Family Favorites Formula Review
Blue Seal
BOGO Bowl Dog Food (Dry)
Boka Dog Food (Dry)
Bonafide Dog Food (Dry)
Boreal Grain Free (Dry)
Born Free Dog Food (Dry)
Bravo
Breakaway Dog Food (Dry)
Breeder’s Choice Active Care Healthy Joint (Dry)
Brother’s Complete
Bully Max High Performance (Dry)
By Nature
Caliber Dog Food (Dry)
Canidae
Canine Caviar
CaniSource Grand Cru Dog Food (Dehydrated)
Carna4 Dog Food (Dry)
Caru Classic Stews Dog Food (Cartons)
Castor and Pollux
Cesar
Chicken Soup for the Soul
Cocolicious Dog Food (Canned)
Country Magic Dog Food (Dry)
Country Squire Dog Food (Dry)
Country Vet
Crave Dog Food (Dry)
Dad’s
Darwin’s
Dave’s
Defender Dog Food (Dry)
Diamond
Doc’s Choice Dog Food (Dry)
Dog for Dog Dogsfood (Dry)
Dog Lovers Gold (Dry)
Dog Power Dog Food (Dry) Mounds
Doggy Bag Dog Food (Dry)
Dogswell
Dr. Gary’s
Dr. Harvey’s Oracle Dog Food (Freeze-Dried)
Dr. Tim’s
Drs. Foster
Dynamite Dog Food (Dry)
Eagle Pack
Earthborn
Elevate
Emma Lou’s Homemade Kitchen (Cooked Frozen)
Eukanuba
Evanger’s
Evermore Dog Food (Cooked Frozen)
Everpet Dog Food (Dry)
Evolution Diet
Evolve
Ex-Cell Pro Dog Food (Dry)
Exclusive Dog Food (Dry)
Extreme Dog Fuel Elite Nutrition (Dry)
Farmina N&D
First Choice Dog Food (Dry)
FirstMate
Forza10 Legend (Dry)
Fresh Is Best Dog Food (Freeze-Dried)
Freshpet
Fromm Family
Full Balance Dog Food (Dry)
Gather Dog Food (Dry)
Genesis RAW Dog Food (Raw Frozen)
Gentle Giants Dog Food (Dry)
Go!
Good Natured Dog Food (Dry)
Grandma Lucy’s
Grandma Mae’s
Gravy Train
Great Canadian Dog Food (Dry)
Great Life
Grreat Choice
H-E-B
Halo
Hank’s Dog Food (Dry)
Happy Paws Dog Food (Dry)
Harvest Blend Dog Food (Dry)
Health Extension
Heartland Reserve Dog Food (Dry)
Hi-Point Dog Food (Dry)
Hi-Standard
Hi-Tek
Hi-Tor Veterinary Select (Dry)
Hill’s
Holistic
Honest Kitchen
Horizon
Hound and Gatos Dog Food (Canned)
Hubbard Life Dog Food (Dry)
Humankind Dog Food (Dehydrated)
Hungry Hound Dog Food (Dry)
Hunter’s Special Dog Food (Dry)
Husse Opus Dog Food (Dry)
I and Love and You
Iams
Infinia Dog Food (Dry)
Inukshuk Dog Food (Dry)
Ivet Healthy Gourmet Dog Food (Dry)
Jack’s Premium Dog Food (Dry)
Jake’s Choice Dog Food (Dry)
Joy Dog Food (Dry)
K-9 Kraving Dog Food (Raw Frozen)
K-9 Natural Freeze Dried Raw (Freeze-Dried)
Kal Kan Dog Food (Dry)
Kasiks
Kent Dog Food (Dry)
Kibbles ‘n Bits (Dry)
Kinetic Performance Dog Food (Dry)
Kirkland
Koha Limited Ingredient Diets (Canned)
Kruse’s Dog Food (Dry)
Lassie Natural Way (Dry)
Leonard Powell
Life’s Abundance
LiveSmart
Lotus
Love Grub Dog Food (Dry)
Loyall Dog Food (Dry)
Lucky Dog Cuisine (Cooked Frozen)
Luvsome
Maintain Chunks Dog Food (Dry)
Maximum Bully Dog Food (Dry)
Member’s Mark Dog Food (Dry)
Merrick’s
Mighty Dog (Canned)
Millies Wolfheart Dog Food (Dry)
Muenster Natural Dog Food (Dry)
My Perfect Pet (Cooked Frozen)
National Dog Food (Dry)
Native Performance Dog Food (Dry)
Natural Balance
Natural Planet Dog Food (Dry)
Nature’s Kitchen
Nature’s Logic
Nature’s Recipe
Nature’s Select
Nature’s Variety
Newman’s Own
Northwest Natural’s
Now Fresh Dog Food (Dry)
NRG Maxim (Dehydrated)
Nulo’s
Nunn Better Dog Food (Dry)
Nusentia Raw and Grain Free (Dehydrated)
Nutra Nuggets Dog Food (Dry)
Nutram
Nutreco
Nutrena Dog Food (Summary)
Nutri Life
Nutrience
Nutrisca
NutriSource
Nutro
Nutro Wholesome Essentials Formula Review
Nutro Max Formula Review
Nutro Ultra Formula Review
Nutro Grain-Free Formula Review
Nutro Petite Eats Formula Review
Nutro Healthy Stews Formula Review
Nutro Kitchen Classics Formula Review
Nutro Limited Ingredient Formula Review
Nutro Puppy Formula Review
Nutro Wild Frontier Formula Review
NVC
OC Raw Dog Food (Raw Frozen)
Ol’ Roy
Old Glory Dog Food (Dry)
Ole Jack’s Dog Food (Dry)
Oma’s Pride Raw Mixes (Raw Frozen)
Only Natural
Open Farm Dog Food (Dry)
Orijen
Oven-Baked
Paramount Dog Food (Dry)
Party Animal
Paw Tree
PC Nutrition
Pedigree
Perfect Balance
Perfectly Natural Dog (Dry)
Performatrin
Pet Chef Express (Dry)
Pet Pantry Dog Food (Dry)
Pet Shoppe Dog Food (Dry)
Pet-Tao Harmony Dog Food (Canned)
Petcurean Dog Food (Summary)
PetGuard
PetKind
PetWay Dog Food (Dry)
Pinnacle
PMI Nutrition Dog Food (Dry)
Precise Holistic
Premium Edge Dog Food (Dry)
Pride Dog Food (Dry)
Primal
Pro Pac
Pro-Form Dog Food (Dry)
Pro-Pet Dog Food (Dry)
Professional Plus Dog Food (Dry)
Pronature
ProSeries Dog Food (Dry)
Pure Balance
Pure Harmony Dog Food
Pure Vita
Pure Dog Food (Cooked Frozen)
Purina
Purina One SmartBlend Formula Review
Purina One SmartBlend True Instinct Formula Review
Purina Pro Plan Focus Formula Review
Purina Pro Plan Savor Formula Review
Purina Pro Plan Bright Mind Formula Review
Purina Beyond Formula Review
Purina Dog Chow Formula Review
Purina Mighty Dog Formula Review
Purina Puppy Chow Formula Review
Purina Moist & Meaty Formula Review
Purina Bella Formula Review
Q Holistic Dog Food (Dry)
Quality Care Plus (Dry)
Rachael Ray Nutrish Dog Food
Rachael Ray Nutrish Original Formula Review
Rachael Ray Nutrish Zero Grain Formula Review
Rachael Ray Nutrish Dish Formula Review
Rachael Ray Nutrish PEAK Formula Review
Rachael Ray Nutrish Just 6 Formula Review
Raw Bistro Dog Food (Raw Frozen)
Raw Wild Dog Food (Raw Frozen)
RAWZ
Real Meat Company (Dehydrated)
Red Flannel Dog Food (Dry)
Red Mills Dog Food (Dry)
Redbarn
Redford Naturals Dog Food (Dry)
Redpaw
Regal Dog Food (Dry)
Renew Gold Balance (Dry)
Retriever Dog Food
Rex Dog Food (Dry)
River Run Dog Food (Dry)
Rollover Super Premium (Rolls)
Royal Canin
Royal Canin Size Health Nutrition™ X-Small & Mini Review
Royal Canin Size Health Nutrition™ Medium Formula Review
Royal Canin Size Health Nutrition™ Maxi Review
Royal Canin Size Health Nutrition™ Giant Formula Review
Royal Canin Breed Health Nutrition™ Formula Review
Royal Canin Lifestyle Health Nutrition™ Formula Review
Royal Canin Canine Health Nutrition™ Formula Review
Royal Canin Veterinary Diets® Formula Review
Rudy Green’s Doggy Cuisine (Cooked Frozen)
Satori Stride Dog Food (Dry)
Seminole Feed (Dry)
Shep Dog Food (Dry)
ShowTime Dog Food (Dry)
Simply Natural Grain Free (Dry)
Simply Nourish
Simply Right
Simply Wild Dog Food (Dry)
Skippy Dog Food (Canned)
Skoki Dog Food (Dry)
Smack Raw Dehydrated Dog Food (Dehydrated)
SmallBatch Raw Frozen Dog Food (Raw Frozen)
Sojos
Solid Gold
Sonny’s Pride Dog Food (Dry)
Source Dog Food (Dry)
South Star Grain Free (Dry)
Southern States
Sport Dog Food Elite Series (Dry)
Sportmix
Sportsman’s Pride (Dry)
Spot Farms
Star Pro Dog Food (Dry)
Stella and Chewy’s
Steve’s Real Food
Stewart Raw Naturals
Strongpoint Dog Food (Dry)
Summit Dog Food (Dry)
Supreme Dog Food (Dry)
Supreme Source Dog Food (Dry)
Taste of the Wild
Taste of the Wild Dry Food Review
Taste of the Wild Canned Food Review
Taste of the Wild PREY Formula Review – L.I.D
Tender & True Dog Food
Three Dog Bakery
Tiki Dog Food
Timberwolf
TLC Whole Life Dog Food (Dry)
Tomboy Dog Food (Dry)
Tops Dog Food (Dry)
Total Canine Dog Food (Dry)
Trader Joe’s Dog Food (Dry)
Tripett Dog Food (Canned)
Triumph Dog Food (Dry)
TruDog Dog Food (Freeze-Dried)
Tucker’s
Tuffy’s
Tuscan
Twin Pet Dog Food (Dry)
Tylee’s Dog Food (Cooked Frozen)
Under the Sun
V-Dog (Dry)
Valens Dog Food (Dry)
Variety
VeRUS Dog Food
Victor Super Premium Dog Food
Victor Dog Food Original Formula Review
Victor Grain-Free Formula Review
Victor Dog Food Select Formula Review
Vital Essentials
VitaLife
Waggers TenderMoist Dog Food (Pouch)
Wegmans
Wellness
Wellness Complete Health Formula Review
Wellness Core Formula Review
Wellness Ninety-Five Percent Formula Review
Wellness Petite Entrees Formula Review
Wellness Simple LID Formula Review
Wellness Stew Dog Food Formula Review
Wellness TruFood Formula Review
Weruva
Whole Earth Farms
Whole Life LifeBites
WholeHearted
Wild Calling!
Wishbone Dog Food (Dry)
Wysong
Young Again Dog Food (Dry)
Zach’s Quality Dog Food (Dry)
Zignature
Ziwi Peak
Zoe’s
Zoic Dog Food (Dry)
Zuke’s
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Feeding Frequency Notes -* This field is required.Comments on food that your pet eat, how often and how much?
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Activity normal?* This field is required.Is your pet active and eating normally?
Yes
No
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Flea/Tick Control:Help us to understand your Pet's Heartworm and Flea Control:
I don't use any currently.
I use a Flea and Tick product that Amberwood supplies.
I use over the counter or online collars.
I use over the counter or online topical products.
I use over the counter or online oral products.
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Any Symptoms?Please select any symptoms your pet is experiencing:
Coughing/Sneezing
Vomiting
Diarrhea
Lameness
Abnormal Urination
Itchiness
Eye issues
Ear Issues
Skin issues
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Please rate your pet's pain level on a scale of 1-5.* This field is required.
1
2
3
4
5
No pain
High degree of pain
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Medications and frequency?Please list any of your pet's medications and frequency
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Prescription refills?Do you need refills or Prescriptions on any food or medications?
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Other concerns?Any other concerns we should address today?
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Please attach any related picture or forms (Rabies certificate, records)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Let's Review:Based on your Input, We'd Like to Review the Following
Core Vaccine Schedule (Rabies, etc)
Lepto and Lyme Disease
Bordetella and Canine Flu
Blood Pathogens (Heartworm, Lymes, Ehrlichia, and Anaplasmosis)
Dental Disease
Intestinal Parasites (bring a Fecal)
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Vaccines to Review:Based on your Responses, we want to make sure to Review:
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Great Summer Opportunities:With the rising cost of Care for our Family Pets, we have partnered with a Regional Laboratory and Credit support companies to offer exciting packages this summer.
Should be Empty: