• Patient History Questionnaire

  • Why is your pet coming to see us?*
  • If you selected Cat Annual Wellness Visit, what services would you like your pet to receive while they're here?
  • If you selected Dog Annual Wellness Visit, what services would you like your pet to receive while they're here?
  • What is your pet eating? Please select all that apply:*
  • Has your pet been eating normally?*
  • Does your pet have chew toys?*
  • How is your pet's water consumption?*
  • Is your pet on a heartworm preventative?*
  • If yes, how often do you provide heartworm preventative?
  • Is your pet on a flea/tick preventative?*
  • If yes, how often do you provide flea/tick preventative?
  • Is your pet on any other medications?*
  • Is your pet on any supplements?*
  • Has your pet had any coughing?*
  • Has your pet had any sneezing?*
  • Has your pet had any diarrhea?*
  • Has your pet had any vomiting?*
  • How many minutes of exercise is your dog getting per day?*
  • How is your pet's energy level?*
  • Does your pet go outside?*
  • If your pet goes outside, does your pet go for walks?
  • Does your pet go anywhere for boarding?*
  • Does your pet go anywhere for grooming or daycare?*
  • Do you have any recent travel history outside of New England?*
  • Does your pet see any other veterinarians or animal care specialists?*
  • Do you have insurance for your pet?*
  • Is there anything else you would like your veterinarian to be aware of?*
  • As Fear Free Certified Professionals, we want to make your pet's veterinary experience as enjoyable and stress-free as possible. Are you interested in providing more information about your pet's behavior so we may accommodate their needs upon arrival?*
  • Does your pet show any reluctance to getting in the carrier or car?*
  • During travel to the veterinary hospital, does your pet do any of the following:*
  • Does your pet prefer:*
  • Check any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end.*
  • Should be Empty: