Pre-Exam Questionnaire

Owner Information*

First NameLast Name

We are so excited to see you and your pet here at FurWell at Barkingham. Please take just a few moments to fill this form out prior to your upcoming visit with us. This will make sure the staff is prepared and allow them time to focus on you and your pet while you are here. If you have any questions, please give us a call or textat 864-458-8500.

Appointment Tip: If you have time please bring in a sample of your pet's stool. Most pets don't like us to collect a sample in the office. If we don't need it at this visit we will dispose of the sample for you.

Pet Name*

Please explain in as much detail as you can why we are seeing your pet.*

Is your pet experiencing any diarrhea or vomiting? If yes, please explain below such as when did it start, how often, and what consistency.*

Is your pet experiencing any coughing or sneezing? If yes, please explain below such as when did it start, how often, and what color is the discharge if any. *

Have you noticed any new lumps or bumps on your pet? Please explain in detail how many, where are they located, when did you notice them at first, are they causing them any discomfort? *