New Pet Wellness Questionnaire
(Please complete prior to your consultation)
Owner Information
Full Name:
*
Email Address:
*
example@example.com
Phone Number:
*
Format: (000) 000-0000.
Mailing Address:
*
Pet Basics
Pet's Name:
*
Species:
*
Breed (or mix if known):
*
Age or Date of Birth:
*
Sex:
*
Spayed/Neutered (if applicable):
*
How long has your pet been in your care?
*
Background & Early History
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Where did your pet come from? (breeder, rescue, rehomed, etc.)
*
Do you know anything about your pet's early history (pregnancy, birth, early care)?
*
Current Health
How would you describe your pet's overall health right now?
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Are there any current symptoms or concerns? (briefly describe)
*
Diet & Feeding
What is your pet currently eating? (brand, type, or homemade description)
*
How often are you feeding your pet each day?
*
How would you describe your pet's appetite?
*
Digestion
How would you describe your pet's stool quality?
*
Any history of vomiting or digestive upset? If so, please describe:
*
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Vaccines & Preventatives
Has your pet received any vaccines so far? If yes, which ones (if known)?
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Is your pet currently on any flea/tick/heartworm preventatives? If yes, which ones?
*
Medications & Supplements
Is your pet currently on any medications? If yes, please list:
*
Is your pet taking any supplements or herbals? If yes, please list:
*
Behavior & Personality
How would you describe your pet's personality?
*
Any concerns with behavior, anxiety, or training?
*
Lifestyle & Environment
Please describe your pet's daily environment (indoors, outdoors, other pets, etc.):
*
Are there any regular exposures (woods, daycare, travel, etc.)?
*
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Your Goals
What are your main goals for this consultation?
*
Final Thoughts
Is there anything else you'd like me to know about your pet?
*
Optional (but helpful)
On a scale of 1-10, how committed are you to taking a proactive, holistic approach to your pet's health?
*
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