Cardiff Animal Hospital & Wellness Center

  • Cardiff Animal Hospital

    PATIENT CONSULTATION QUESTIONNAIRE
  •  -
  • Is this a cell phone?*
  • Are you aware of anything that may have caused the symptoms?
  • Is your pet's ACTIVITY*
  • Is your pet's APPETITE*
  • Is your pet's THIRST*
  • Is your pet's URINATION*

  • Is your pet COUGHING?*
  • If yes,*

  • Is your pet SNEEZING?*
  • If yes,*

  • Is your pet VOMITING?*
  • If yes,*

  • Does your pet have DIARRHEA?*
  • If yes,*
  • Is your pet's mobility*
  • Does your pet have any NEW MASSES or SKIN LESIONS?*

  • General Wellness

    DIET & TREATS
  • Is this diet grain-free?*
  • Is this a raw diet?*
  • How often is your pet fed?*

  • Does your pet get treats or table-scraps?*

  • General Wellness

    DENTAL CARE
  • Do you brush your pet's teeth?*
  • Do you give your pet dental treats?*
  • Were dental x-rays performed?*

  • General Wellness

    MEDICATIONS & CURRENT TREATMENTS
  • Is your pet on any current medications?*
  • Do you give your pet any supplements (i.e., glucosamine, omega fatty acids, probiotics, etc.)*
  • Is your pet on a Heartworm preventative?*
  • Is your pet on a flea or flea and tick preventative?*

  • General Wellness

  • If your pet is a cat, what percent of time does your cat spend outdoors?*
  • Has your pet traveled outside the area in the past 12-months?*
  • Do you plan for your pet to travel outside the area in the upcoming 6-months?*
  • Does your pet have pet insurance?*
  • Are there other pets in the household?*
  • Does your pet have a microchip?*
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