Wellness Check In: Dogs over 6 months old

Wellness Check-In Form: Dogs over 6 months old

Please be prepared for this form to take about 10 minutes to fill out. If you are a new client, please have your pets medical records handy as there will be a section to upload them at the end of this form.
Client Name*

First NameLast Name
Pet Information
Name *
Age
Sex
Breed

What food are you feeding your pet currently and how often? *
Is your pet's appetite normal? *
How has your pets appetite changed? Is this a new problem or ongoing? Is there anything else you want us to know about this problem?
Has your pet had any vomiting or diarrhea recently? *
How often is your pet experiencing vomiting or diarrhea? Is this a new problem or ongoing? Is there anything else you want us to know about this problem?
Has your pet had any coughing or sneezing recently? *
How often is your pet experiencing coughing or sneezing? Is this a new problem or ongoing? Is there anything else you want us to know about this problem?
Is your pet drinking and urinating normal? *
What has changed with their drinking and urination habits? Is this a new problem or ongoing? Is there anything else you want us to know about this problem?
Is your pet on any current medications besides heartworm, flea and tick prevention? *
What medications are they currently on? Please list the dosage they are getting and how often you are giving it.
Do you need any refills for any of these medications? If yes, please list which ones.
Do you have any other questions or concerns that you want to discuss during your pet's visit? *

Does your pet need vaccinations?*

YesNo

Vaccinations we recommend for all dogs:
- Rabies: 1 or 3 Year
  - If your pet is up to date or within 30 days of the due date for their current Rabies vaccine, the one given will be a 3 year.
- DAPP/DHPP (Distemper/Parvo): 1 or 3 Year
  - If your pet is up to date or within 30 days of the due date for their current DHPP vaccine, the one given will be a 3 year.
- Leptospirosis
  - If already vaccinated with lepto, this will be a year vaccine.
  - If never had lepto vaccine before your pet will need 2 initial doses, 2-4 weeks apart, regardless of age.
  - Revaccinate annually after initial series is complete.
  - Most common zoonotic disease in the US, spread through urine of infected animals
- Bordetella (Kennel Cough)
- Influenza is dependent on your pets lifestyle.
What vaccines does your pet need? If you don't know, leave blank and we will look at your pet's records to help figure it out.

RabiesDAPP/DHPPBordetellaLeptospirosis

Diagnostic testing we recommend for dogs:

All dogs over 6 months old:
- Intestinal parasite screen/fecal test annually
  - This is to test for hookworms, roundworms, and other common intestinal parasites.
- Heartworm Testing
  - We recommend every dog over 1 year old be tested for heartworms every 12 months.
  - Heartworms are prevalent in the southeast and can be deadly and difficult to treat.
Dogs between 3 years and 7 years old:
- Annual bloodwork testing - CBC and chemistry panel
  - This is to check red blood cells, white blood cells, platelets and organ function.
Dogs over 8 years old:
- More in-depth bloodwork: CBC and superchem panel, thyroid testing and urinalysis.
  - This is to check red blood cells, white blood cells, platelets and organ function more in depth and to check thyroid function.
Has your dog had a heartworm test within the last year?*
Has your dog had an intestinal parasite screen/fecal within the last year?*

Is your pet on heartworm prevention? (ex: Heartgard, ProHeart, Trifexis, Simparica Trio)
What type of prevention are you giving currently?
Are you interested in ProHeart12 - this is an injectable heartworm prevention that lasts for 12 months. We always recommend this product as it makes annual heartworm prevention much easier and you don't have to remember a monthly pill or chewable.

Is your dog currently on flea/tick prevention?
Which flea/tick prevention are you using currently?

Wellness Plans

We offer Wellness Plans at Paw Haven. These are tiered subscription-based plans that include all of your pet's wellness needs.

Wellness Plan Inclusions:
- Annual physical examination by a veterinarian
- Sick Appointment Co-Pay $30
- Recheck Appointments Co-Pay $20
- Unlimited technician appointments for preventative care services deemed necessary by our veterinarians
- Preventative vaccinations
- Annual diagnostics based on tier selection (Intestinal parasite screen, Heartworm testing, +/- organ function testing based on plan selection)
- Dogs: Heartworm Prevention: ProHeart12*
- Any other preventative care services recommended by our veterinarians
- 10% off all flea/tick preventatives
*If pet is under 12 months old, Iverheart Plus will be used until pet is 12 months old. Client will be sent home with 3-
6 months of prevention at a time.

Dental Cleaning and/or Spay/Neuter Add-Ons
- These are add-on options for wellness plans that include:
  - Dental: routine dental cleaning with x-rays annually, includes pre-op bloodwork
  - Spay/Neuter: entire spay/neuter procedure including pre-op bloodwork, medications to go home and medical pet shirt or cone.
To Learn Specifics for the Wellness Plans please visit our website for pricing and detailed inclusions: Wellness Plans at Paw Haven
Do you want to sign up for a wellness plan for your pet? If you would like to sign up for a Wellness Plan we will send you the contract to sign before your appointment. Payment will not be taken until the appointment.

Please upload any records you have for your pet including vaccine reminders.

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Wellness Check-In Form: Dogs over 6 months old

Pet Information

Vaccinations we recommend for all dogs:

Diagnostic testing we recommend for dogs:

Wellness Plans

Dental Cleaning and/or Spay/Neuter Add-Ons

To Learn Specifics for the Wellness Plans please visit our website for pricing and detailed inclusions: Wellness Plans at Paw Haven