Sick Pet Appointment Form
This form is designed to help our team gather important information about your pet's current status for your upcoming visit with our team!
Full Name
*
First Name
Last Name
Primary Phone Number
*
Pet's Name:
*
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When did your pet start experiencing symptoms?
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What exactly are you seeing at home?
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If your pet is having diarrhea, approximate how many times per day:
Describe the diarrhea (large puddles, small droplets, blood in it, any mucous, etc):
Stool Quality Score
*
Please Select
1
2
3
4
5
Score from 1-5, 1 being profuse diarrhea, 5 being extremely hard
If your pet is vomiting, approximate how many times per day:
Describe the vomit (large puddles, small foamy vomit, blood in it, etc):
Have you brought a stool sample today?
*
Yes
No
What changes have you noticed in your pet’s personality or behaviors?
*
What diet is your pet currently eating?
*
Please upload pictures of any food, treats, medications or supplements your pet is currently taking:
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How long has your pet been on this diet?
*
What table scraps/homemade cooking or treats does your pet get?
*
When was the last bag of food opened?
*
Does your pet... (your opinion)
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Drink too much water
Drink the right amount of water
Not drink enough water
Is your pet peeing more than usual?
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Yes
No
Have there been any recent accidents in the house?
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Yes
No
Does your pet attend grooming/boarding/daycare/dog park facilities?
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Yes
No
Does your pet hunt?
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Yes
No
Does your pet roam freely outdoors?
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Yes
No
Does your pet eat feces/drinks outdoor water from wildlife/other pets/its own?
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Yes
No
Does your pet have possible access to the compost/garbage/recycling?
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Yes
No
Unsure
Is there a chance your pet ingested a foreign object (sock, toy, medication, etc)?
*
Yes
No
Unsure
Did we forget something?
Please list any questions/problems/concerns that you would like addressed
Thank you for answering all of our questions, it helps us to deliver a more thorough and comprehensive experience for you and your pet!
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