Annual Physical Exam Pre-Appointment Questionnaire

Annual Physical Exam Pre-Appointment Questionnaire
Contact Information Review

Please review and update the primary contact information we have on file.
Pet Name
Pet Name
Primary Owner Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Email(s)
Contact emails separated by comma
Phone Number
Please enter a valid phone number.
Any additional contact information updates?
Have there been any changes in the above contact information?*

Yes, please update my file.No, there have been no changes.
Is your dog insured?

YesNo
Please provide the insurance provider details and policy number if there have been any changes. If we already have these details, feel free to skip this section.

Oral Health
Do you brush your dog's teeth? If so, how often?

YesNo
Please let us know how often:
Is your dog experiencing any dental problems or symptoms (e.g., bad breath, difficulty eating, excessive drooling)?

YesNo
If Yes, please describe them:

Concerns
Are there any specific worries, concerns or questions you would like to discuss with the veterinarian during the Annual Physical exam?
We'd love to learn more about your dog and what they mean to you! Please tell us what you love the most about your furry friend 🐶 !

Since your last visit with us, has your dog been seen by another veterinarian (including at a cottage, specialist, or emergency clinic etc.)? Please let us know, as we may not have received their medical records. This information is vital to ensure we provide the best possible care for your pet.
Your furry friend's comfort is important to us. Is there anything specific about your dog's preferences or behaviour (such as favourite treats, being more comfortable when held by you, etc) or any other things that can help us create a more relaxed experience during the exam?
To help keep accurate and detailed medical notes, our doctors may choose to record audio during the appointment. We value your privacy - if you would like to opt out of voice recordings, please let us know:*

Sure! The doctor may record our appointments.I'd rather not - please opt me out of voice recordings.
A Note About Your Appointment:

To help our doctors keep accurate and detailed medical records, we use an AI-powered note assistant that records and securely transcribes portions of your appointment. These recordings are used only to support accurate documentation and remain strictly confidential at all times.

If you’d like to learn more, our doctors are always happy to discuss this with you.
Should be Empty:

Diet, Medications and Supplements