Full Exam History Questionnaire

  • Medical History Exam Questionnaire

    Your pet has been scheduled for an examination with a veterinarian. Please bring a fresh stool sample from your pet to their appointment if your pet is having any gastointestinal symptoms like bowel movement irregularities or vomiting. 

    **Please fill out this form to the best of your ability prior to your appointment**

  •  -
  •  -

  • Please compete this form to the best of your ability 

    Your pet has been scheduled for an examination with a veterinarian. Please fill out this form completely to the best of your ability prior to your appointment. Please bring a fresh stool sample from your pet to their appointment if your pet is having any gastointestinal symptoms like bowel movement irregularities or vomiting. 

  • Check the conditions that apply to your pet.*

  • Check the symptoms that your pet is currently experiencing:*

  • OA Checklist

    In preparation for your pet's exam, we have some specific questions regarding your pet's movement and interaction at home. Please take 1-2 videos lasting 15-20 seconds each of your pet's movement. This video can be helpful as some pets are shy while visiting our clinics.
  • Is your pet a dog, cat or other?*

  • Think about your dog's activity in the past week. Check all the signs you've observed in your dog. (Please refer to the image below as reference)*
  • Image field 61
  • Do you think your dog shows signs of pain?*
  • Have you noticed any changes in your dog's behavior?*
  •    
  •    
  •    
  •    
  • Has your pet ever been injured?*
  • Have you ever given your dog medication for pain, such as aspirin?*
  • Has your dog gained weight in the past year?*
  • Think about your cat's activity in the past week. Check all the signs you've observed in your cat. (Please refer to the image below as reference)*
  • Image field 76
  •    
  •    
  •    
  • Has your cat's personality and sociability changed?*
  • Has your Cat's urination or defecation habits changed?*
  • Is your cat hiding more or does your cat seem to be "slowing down"?*

  • Medication/Supplement(s)

    Please list all medications/vitamins/supplement/preventatives that your pet is currently taking.

  • Please arrive to your appointment at your scheduled time.  Due to our current scheduling restrictions, if you are not able to arrive on time, we may need to reschedule your appointment.

  • Thank you for taking the time to complete our form. The information you provide is valuable and enables us to provide the best care for your pet. If there is anything else you'd like to discuss or to be evaluated, please communicate it to a team member prior to your appointment or at the beginning of your pet's appointment. 

    We look forward to seeing you at your upcoming appointment

    Warm regards,

    Your veterinary team at the Aurora Animal Care Community

  • Should be Empty: