Sick Exam: Pre-Visit Questionnaire
Thank you for allowing us to care for you and your family. In an effort to better care for your pet, we ask that you complete this Pre-Visit Questionnaire so that our team can review your pet's medical history. Please take a moment to answer the following questions prior to your appointment.
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Reason for visit
How did you hear about Animalia?
Current symptoms or abnormal activity (coughing, bleeding, weight loss, lethargy, limping, sneezing, vomiting, diarrhea, frequency and volume)? How long have these symptoms been present?
Does your pet have any previously diagnosed medical conditions?
Is your pet currently taking any medications or preventative medications? What dosage?
Has your pet had any surgeries other than his/her spay or neuter?
What is your pet's current diet?
Does your pet or anyone in your household have a food allergy?
Please provide the name and phone number of previous clinics where we can obtain medical records. This information can also be emailed directly to us at email@example.com
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