Canine Wellness Form

Canine WELLNESS visit

Dog's with health concerns and annual vaccinations
You are receiving this form in advance of your pet's appointment at Bendigo Pet Vets to allow us to improve our efficiency and communication with you.

Feel free to communicate questions or concerns prior to your visit.
Date of Appointment

MonthDayYear
Date
Your First Name & Surname*
Your Pet’s Name*
Please provide us with your best contact number
Please park outside the fence and bring your dog in on a leash inside the gated area. If there are other clients or patients in the fenced area you can wait for a team member to help you check in. Please let us know if we can better accommodate you or your dog during the visit.

My dog has limited mobility and needs help walkingI will need assistance getting my dog in or out of the vehicleMy dog is very reactive and it would be best if contact with other pets is avoidedOther
Your dog is scheduled for a WELLNESS visit, what questions or concerns would you like to bring to the doctor’s attention?
Current medications or supplements (other than heartworm prevention)
What are you currently feeding your dog?
Dental / Oral health

I am currently brushing my dog’s teethI am using dental treats or chewsI would like more information about at home dental careI think my dog may need a professional dental cleaningNoneOther
Heartworm Prevention

Currently using and will continue with current planCurrently or previously using but would like to discuss an alternative planI am interested in discussing injectable HWP every 12 months vs. monthly oralNot currently using heartworm prevention and not interested in startingI need information about the importance of heartworm preventionI need a refill of heartworm prevention at this visit
Flea and Tick Treatment / Prevention

Currently using and will continue with current planCurrently or previously using but would like to discuss an alternative planI need a more effective form of flea and tick treatment / preventionI need a refill of flea and tick treatment / prevention at this visit
I have noticed

Loss of mobility, lameness, limping or discomfortLumps or bumps on or under the skinUrine or stool accidents or changes in toileting habitsBad breath or changes with teeth / gumsIncreased water intakePoor appetiteWeight GAINWeight LOSSNoneOther
Need any further help? Medication refill, Food refill, Other?
Are there images or videos that would be helpful for todays visit?

Cancelof
Should be Empty:

Canine WELLNESS visit