Pet's Name: (required) Please list everything your pet eats, including treats: (required) Has your pet ever had an allergic reaction? (required) Yes NoIf 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?