• Patient History Questionnaire

    Please completely fill out the Patient History Questionnaire form prior to your appointment.
  • Why is your pet coming to see us?*
  • What is your pet eating? (Please select all that apply)*
  • How often do you brush your pet's teeth?*
  • Has your pet been eating normally?*
  • How is your pet's water consumption?*
  • Is your pet on heartworm preventative?*
  • How often do you give your pet heartworm prevention?*
  • Is your pet on flea/tick preventatives?*
  • How often do you give your pet flea/tick prevention?*
  • Is your pet on any other medications?*
  • Is your pet on any supplements?*
  • Do you need any refills of the above today?*
  • Has your pet had any of the following:*
  • Does your pet have any lumps or bumps you would like looked at?*
  • Has your pet had any issues with their skin?*
  • Has your pet had any ear issues?*
  • How many minutes of exercise is your pet getting a day?*
  • How is your pet's energy level?*
  • Does your pet go outside?*
  • Do you board your pet?*
  • Do you take your pet to a groomer?*
  • Do you take your pet to a daycare facility?*
  • Any travel history outside of New England?*
  • Does your pet see any other veterinarians or animal care specialists?*
  • Do you have insurance for your pet?*
  • Have you had any contact with people known or suspected to have COVID-19 in the prior 14 days?*
  • Should be Empty: