• Pre-visit Questionnaire

    WELL VISIT HISTORY FORM- This form helps us learn about your pet’s daily care, habits, and lifestyle so we can provide the best preventive health recommendations during their visit.
  • Type of Pet*
  • How old is your pet?*
  • Is your pet eating and drinking normally?*
  • Is your pet currently taking any medications?*
  • Do you need a refill on any of your pets medications?
  • Have you noticed any of the following:*
  • Does your pet have any known allergies or has your pet ever had any reactions to injections or vaccines?*
  • Does your pet go to a groomer, boarding facility, dog park, dog/cat shows, day care, or travel with you?*

  • Annual Vaccines

  • Has your pet had vaccines (annually or as part of a series)?*

  • Series Vaccines- Most vaccines must be started as a series to provide full protection. The series usually begins when your pet is at an appropriate age and requires boosters every 3–4 weeks until complete. This means you’ll need to return for multiple visits. Please note: if a vaccine given as part of a series is missed, the series will need to be restarted to ensure your pet’s safety and immunity.

  • Are you interested in starting vaccine series today*
  • Are interested in updating your pet's vaccines?*
  • Dog Vaccine Options: Please choose those you are interested in updating.
  • Cat vaccine Options: Please choose those you are interested in updating.
  • Are you interested in updating your pet's annual heartworm test if due?*
  • If your cat travels or spends time out of doors, we recommend they be screened for FELV (Feline Leukemia) and FIV annually. Are you interested in updating your pets annual FELV/FIV test?*
  • Do you have other pets at home?*
  • Because a pet’s health can change with age, pets over the age of 7 are considered Seniors and routine bloodwork is recommended to screen for conditions more prevalent with older pets like: Diabetes, Liver Disease, Kidney Disease and Thyroid Disease just to name a few.
  • Are you interested in enrolling your pet in a wellness plan?
  • Have you downloaded our Funkstownvet app and become a member of our loyalty rewards program?*
  • Client Acknowledgements:*
  • Should be Empty: