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Willard vet's know your dog questionnaire!
Please fill this out as best you can before your appointment to let your doctor get to know your dog a little better!
19
Questions
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1
Name of your dog
*
This field is required.
your pets name
your last name
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2
Your Name
*
This field is required.
or the owner of the pet's name
First Name
Last Name
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3
Phone Number
*
This field is required.
this is to contact you if we need more information for any reason!
who's number is this
Phone Number
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4
Have you been to a previous vet office?
tell us the name of any previous vets (we need this for an exam!)
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5
Is your dog...
*
This field is required.
pick an age range that fits
a young dog 0-2
an adult dog 3-7
a senior dog 7-12
a super senior 12 +
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6
do you...
*
This field is required.
click any that apply to your dogs lifestyle!
go on walks
go on hikes in wooded or forest areas
brush your dogs teeth
travel with your pet
share a bed with your dog
Allow your pet on the furniture
See wildlife in your neighborhood
none of the above
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7
Where (and how often) do they get groomed?
*
This field is required.
if they are not groomed please enter n/a
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8
What kind of flea and tick product do you use?
*
This field is required.
Let us know if you need refills!
Bravecto
Advantage Multi
Effitix
Credilio
Other
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9
If other, please let us know what brand and where you fill it!
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10
What kind of heart worm prevention do you use?
*
This field is required.
let us know if you need refills
Interceptor/Interceptor Plus
Other
Triheart
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11
If other, what brand do you use and where do you fill it?
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12
Do you use a boarding or day care facility? Where and how often?
*
This field is required.
if you do not use this please enter n/a
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13
Do you use a dog trainer? If so by whom?
*
This field is required.
if they have not been formally trained please enter n/a
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14
Who does your dog live with?
*
This field is required.
click all that apply
Infants 0-2
Children 2-13 years
Elderly
Immune suppressed person (anyone who has an immune disease, on medications that cause them to be immune suppressed, ect.)
Other pets that we do not see here
None of the above
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15
How is you dog doing recently?
*
This field is required.
click all that apply
itchy skin?
lumps/bumps?
coughing/sneezing?
diarrhea/vomiting
do they ever have accidents in the house?
Do they seem more lethargic/tired than normal?
Any trouble going up and down stairs?
Any joint pain/limping/or swelling?
None of the above
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16
Do you use pet insurance
Please let us know who they are and bring a claim form with you to your appointment!
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17
What type of food do they eat, how often, and how much?
*
This field is required.
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18
Are they on any medications?
*
This field is required.
list any they currently take, please let us know at least 48 hours in advance if you need refills!
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19
Anything else you want us to know?
you can also email us with further info or any past records from other vet offices!
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