Seaforth Animal Hospital

80205 North Line
Seaforth, ON N0K 1W0

(519)527-1760

www.seaforthvet.com

Your Pet’s Annual Wellness Review

 

These history questions will help your veterinarian to make individualized recommendations for your pet.
Please complete this questionnaire and email it back to us before your pet’s scheduled appointment.

 

History Questions

Owner's Name: (required)
First Name (required)
Last Name (required)
Phone (required)
Phone TypePhone Number (required)
Pet's Name: (required)

Please list everything your pet eats, including treats: (required)

Has your pet ever had an allergic reaction? (required)

Yes
No


If Yes, to what?

Please list any medical conditions that your pet currently suffers from: (required)

Please list all Medications that your pet currently takes: (required)

Please list all over the counter products or supplements that your pet uses: (required)

Which Parasite Prevention Product(s) is your pet using? (required)

For ALL PETS - check if you pet suffers from: Check all that apply:
Vomiting or diarrhea more than once a week
Any coughing or sneezing
Any itching, scratching, chewing, licking or headshaking
Urinating more or less than before
Drinking more or less than before
Any scooting or licking at the hind end
Any trouble jumping on or off furniture or difficulty with stairs
Any new lumps or bumps
Not playing with toys like before
Any bad breath
For Cats - check if your pet suffers from
Very wet litter box
Sometimes goes outside the litter box
Won’t use a scratching post
Has problems getting along with other cats in the home
Which best describes your CAT’s Lifestyle? Check all that apply:
Indoors always
Outdoors always
Indoors primarily with short outdoor trips
Indoors and outdoors at will
Hunts mice
Which best describes your DOG’s lifestyle? Check all that apply:
Sniffs noses with other dogs out for a walk
Goes to the groomer, dog park, or boarding kennel
Travels outside of Huron County
Eats rabbits, rodents, or groundhogs
Goes hiking, camping, or walking through long grass
Do you have any other question or concerns that you would like the veterinarian to address at your pet’s upcoming appointment?


Verify the reCAPTCHA: