Pet Medical History - Dog & Cat
All fields marketing with * are requred and must be filled out.
Owner Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Pet's Name
*
Species (Cat or Dog)
*
Breed
*
Color
*
Age of Pet
*
Gender
*
Female
Female/Spayed
Male
Male/Neutered
Does Your Pet have any past or ongoing major medical issues?
This question is for CATS ONLY: Does your cat go outside of the house?
Yes
No
Has your pet experienced any adverse reactions to medications or vaccinations? If so, please explain below. Please include the medications/vaccines that caused the reaction(s), what the reactions looked like (gastrointestina/respiratory signs, swelling, etc.), and the approximate date(s) or the reaction(s).
Currently, does your pet take any medications (including heartworm preventatives) supplements or eat a prescription or special diet? Please explain and include the name, strength and frequency of dosing of any medication(s), if possible.
Currently, is your pet on a flea/tick control product? Please explain.
Vaccination History
Please enter the date of the last time your pet received any of the vaccines below. If you have any printed vaccination records, please bring them with you on your first visit or email it directly to the hospital. Please provide approximate dates the vaccines were given below if possible:
Dogs
DHPP/DAPPV (Distemper, Hepatitis, Parainfluenza, Parvo)
Rabies
Leptospirosis
Bordatella ("Kennel Cough")
Canine Influenza
Cats
FVRCP (Upper Respiratory Viruses, Panleukopenia)
Feline Leukemia
Rabies
If your pet has medical records at another hospital, kindly contact that hospital and ask them to forward your pet’s medical records (including vaccine history) to us at redwoodvet@yahoo.com. This will save you a lot of time and help us better understand your pet’s medical background.
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