Appointment History Form
Please complete this form before coming to the hospital. Thank you!
The phone you will have with you at the appointment.
Briefly describe the reason your pet is here for an exam, such as ear infection, sick or limping:
Please mark any symptoms that your pet has been experiencing (select all that apply):
What are you feeding your pet?
What brand, is it wet or dry food
Has your pet's appetite changed?
When was the last time you saw a bowel movement and what did it look like?
For example: Does your pet’s stool look normal in colour? If no, is it black or bloody? If your pet is coming for a vaccine or booster appointment, please bring a fecal sample for parasite screening to your appointment.
Have you seen your pet’s urine? If so what was the colour and amount?
Would you like your pet’s nails trimmed while here? (There is a fee for nail trims unless you have purchased a Healthcare Program.)
Would you like your pet’s anal glands emptied? (additional cost)
Are there any new lumps or bumps you have found?
Is your pet currently taking any flea, tick or parasite medication (for example Revolution, Nexgard)?
Please list all medications your pet is on and when they were last given:
Please provide any additional information that you feel would be helpful in treating your pet today:
Please bring to your appointment all medications your pet is currently taking.
Should be Empty: