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 Name
Last Name
Address
Street Address
Street Address Line 2
City
State / 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?
Yes
No
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.
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Diet, Medications and Supplements
What food does your dog eat?
Please list the brand and specific diet(s).
Does your dog receive meals at set times or have continuous access to food (free feeding)?
Meals at set time
Free feeding
Both
Could you please specify the quantity and frequency of your dog's meals, including how much food (in cups, grams, etc.) is given and how often (e.g., twice a day, morning and evening)?
What treats does your dog get?
Please list the brand and specific treat(s).
Does your dog ever get "human foods"?
Yes
No
If Yes, please list the foods:
Please list the human foods that your pup is receiving. Please indicate the frequency.
Have you noticed any changes in your pup's eating and drinking habits?
Yes
No
Please describe the changes you have noticed:
Is your dog currently on any medications?
Yes
No
Is your dog currently on any medications? If yes, please list the medications, dosages, and administration schedule.
Is your dog currently on any supplements?
Yes
No
Please list the supplements (and their dosages) your dog is on:
What preventive products do you use for intestinal parasites, heartworm disease, flea and tick control? Please indicate the doses your dog is getting.
Are there any known or suspected allergies your dog is suffering from?
Yes
No
Please provide details, including the symptoms you've observed and the reasons you suspect an allergy.
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Behaviour and Lifestyle
Please describe your dog's typical daily exercise routine:
Is your dog experiencing any behavioral issues or changes in behavior (e.g., anxiety, excessive barking, reactivity, aggression)?
Please describe in detail. Please indicate if these are recent or long-term changes. Has there been any recent stressful event or change in the household that might have affected your dog’s behaviour?
Is your dog regularly exposed to other animals or any of the following environments? Please check all that apply:
Daycares
Dog parks/ playgrounds
Boarding facilities
Grooming
Wildlife and/or areas with wildlife
Other
Are there any other pets in your household?
Yes
No
Please provide details about the other pets in your household, including their species, breed, age, and any relevant information about their health or behaviour. If we have already met these pets during a previous visit, you can simply list their names:
This additional information will help your pup's family doctor and our team gain a better understanding of the dynamics in your household and how they might affect your pup's well-being and behaviour
Does your pup travel anywhere?
Yes
No
Please let us know where
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Oral Health
Do you brush your dog's teeth? If so, how often?
Yes
No
Please let us know how often:
Is your dog experiencing any dental problems or symptoms (e.g., bad breath, difficulty eating, excessive drooling)?
Yes
No
If Yes, please describe them:
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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 🐶 !
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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.
Submit
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