Pre-visit form - in clinic

WE KNOW YOUR PET’S HEATH IS IMPORTANT AND WE THANK YOU FOR TRUSTING US TO CARE FOR THEM. TO HELP US PROVIDE THE BEST CARE POSSIBLE, PLEASE TAKE A FEW MOMENTS TO FILL OUT THIS FORM COMPLETELY. THANK YOU!

Owner's name

First NameLast Name

Pet's name

Are there any other issues/concerns you have about your pet? How long has this problem/issue been going on? Please provide a brief summary of any problems/issues

What are you feeding? Name of brand and amounts

Are you currently using heartworm prevention? Please list product you are using and date last given. *Remember heartworm disease is a year-round disease and medication should be given year-round. It only takes one bite by a mosquito to pass heartworm and heartworm disease can be deadly. This is a good time to check to see if you may have missed doses. If you have, it may be time to discuss Proheart, an 12 month injection for heartworm. We can provide you with an estimate of cost at time of visit

Are you currently using flea tick prevention? Please list product you are using and date last given. *Remember that fleas are out year-round. We recommend Bravecto quantum, a injection that last 12 month for flea prevetion

Is your pet on any other medications? Please list them here and how you are giving them. This is to make sure there have been no changes from the prescribed label.

How is your pet's appetite? Normal, increased, decreased?

Is water consumption normal, increased or decreased?

Is urination normal, increased or decreased?

Any changes in the stool?

Any recent or chronic vomiting or diarrhea/loose stool that we should be aware of?

Any recent or chronic coughing/sneezing that we should be aware of?

Please list medications you may need today, including heartworm prevention, flea and tick prevention or refill of medications?

Is it okay for the doctor to run appropriate diagnostics today, like bloodwork, urinalysis and intestinal parasite screen?

Do you need any medication refill, please list the medication?

Are there any other services you would like performed today? Nail Trim ? Anal Gland Expression ? Ear cleaning ? Clipping mattes/hygiene clipping?

Anything else we should know?

Pre-visit questionnaire