Urine & Fecal Drop-Off Questionnaire
Vomiting/Diarrhea & Urinary Issues
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Pet's Name
*
Is your pet still eating and drinking?
*
Yes
No
Is your pet acting sick or lethargic?
*
Yes
No
Is your pet having diarrhea?
*
Yes
No
What brand & type of food is your pet eating? How long? Is this a new bag?
*
What does it look like? Any blood or mucous?
*
Is your pet vomiting?
*
Yes
No
If yes, for how long?
*
What does it look like? Food or bile?
*
Has your pet got into the garbage recently? Are they likely to chew on toys or small items?
*
Is your pet having urinary issues?
*
Yes
No
If yes, please explain what you are noticing (ex. freq. urination, drinking a lot, in & out of the litterbox etc.):
*
Are you noticing blood in the urine?
*
Yes
No
What time did you collect your sample?
*
How did you get your sample? (Ground, counter, caught, etc.)
*
Has your pet been to a kennel or under any new stress? When?
*
Is your pet free roaming or off leash?
*
If this is a drop off sample, do you prefer a call or text with results?
*
Call
Text
Is there anything else you would like us to know?
*
Submit
Should be Empty: