Follow Up Exam - History of Adult Dog or Cat Seen Less Than 6 Months Ago

Follow Up Examination - Virtual Check-In

The following health history/risk assessment is a comprehensive look at your pets most recent health history at home. If we haven't collected this information on your pet in more than 18 months, or if this is the first time we are getting to know your pet, this form is for you and your pet family. It will take about 10-20 minutes to thoughtfully complete, and is best completed by your pet's primary caregiver. Completing this intake to the best of
Pet's Primary Adult Caregiver - Full Name

First NameLast Name
Pet's Other Adult Caregiver(s) if Any
Name(s)
Valid Caregiver E-mail
Pet Patient's Name
Appt Date If Known

MonthDayYear
Date
Changes in Ownership Status within The Last 6 Months
If you are new to this patient, even if we are not, please briefly describe the breeder, rescue or other circumstances under which this pet was obtained. Please estimate the length of of your ownership. If this patient was obtained outside of Evansville, Indiana, where did they live before? Has there been any interruption In ownership (extended stays elsewhere, or with other persons lasting more than a few weeks)? With new patients, or patients regaining a relationship with our clinic, this can be helpful when evaluating risk of certain infectious or non-infectious disease.
If different than the caregiver(s) listed above, who is the adult person presenting this pet patient to Highland during the appointment/check in time?

First NameLast Name
Goals for today's visit
List your understanding of the purpose of this appointment or visit, and/or any questions you have about the appointment.

GENERAL INFORMATION
Patient Species
Date of Birth (Estimate Ok)

MonthDayYear
Age of Patient - Estimate Ok
Indicate above how old your pet may be in terms of weeks, months, or years
Pet's Biological Gender & Reproductive Status If Changed Since Last Visit
Name of veterinarian or other preferred veterinary professionals you have most recently seen or are currently seeing
List any lifestyle or environmental changes since your pet's last visit
Have you moved from the country to the city or vice versa? Is your pet participating in any new classes outside the home? New grooming facility or has your pet traveled?

Patient Behavior & Finish

Sometimes changes in a pet's behavior can indicate pain, illness, or injury. We have just a few more questions to ensure that we have as much information we can use to help your pet. Remember they can't speak and tell us what's wrong, so we count on you and thank you for your patience!
Behavioral Screen

Other
Concerns with Behavior or Emotional Wellness
Your response has indicated your pet may have a struggle with his/her emotional wellness or have a behavioral concern that you would like to address, or that may help us handle your pet's care as comfortably as possible. Please indicate how long this has been going on, or what circumstances or activities you've noticed surrounding this problem. In general, if you have any handling or preferences that you think work best for your pet you may also list or discuss them there.
Medical Progress Photo or Video

Browse Files
If you have a photo, video, or file which you feel is relevant to your visit today, please upload here Cancelof
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Follow Up Examination - Virtual Check-In

GENERAL INFORMATION

Resources

Health Conditions and Health History

Pain & Mobility Screen

Patient Behavior & Finish