Canine Wellness - Battleground Hospital for Animals

In order to help us best treat your pet today, please fill out the following information prior to leaving:

Your Name*

Pet's Name*

My Dog's Lifestyle (Circle One):*

Lifestyle 1 - My Dog - lives indoors and has no contact with other dogs, including grooming and/or boarding visitsLifestyle 2 - My Dog lives indoors/outdoors, visits the groomer, stays for boarding or plays at the dog park/doggy daycareLifestyle 3 - My Dog lives outdoors, lives on a farm or is a working dog

Do you have any concerns today?*

Has your pet ever shown signs of a vaccination reaction? If yes, please describe*

What diet does your pet eat? Please include any table scraps/treats*

Is your pet taking any medications including heartworm/flea/tick prevention? If yes, please provide type & dose*

Have you observed any of the following with your pet? If yes, please describe:

Coughing/Sneezing

Vomiting/Diarrhea

Stiffness/Soreness

Lumps/Bumps

Scratching/Licking/Hairloss

Urinary/BM Problems

Do you have a Doctor preference pertaining to who examines your pet today?

BATTLEGROUND HOSPITAL FOR ANIMALS