Medical Appointment Questionnaire

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Client's Name
Name*
First Last
Cell Phone
Covid-19 - Please let us know if you have recently travelled outside of Canada, are in self-isolation or have any Coronavirus symptoms;
Pet Information
Pet's Name*
What are the concerns you would like addressed during your pet's appointment?
How is your pet's appetite?
What food is your pet being fed?
Does your pet get treats?
May we give your pet a few Benny Bully liver treats during the appointment?
Has there been any change in your pet's water intake? If so, for how long and is it increased or decreased?
How is your pet's energy level? Has there been any change in it?
Has there been any vomiting or diarrhea? If so, please provide details.
Has there been any coughing or sneezing? If so, please provide details.
Does your pet's urination seem normal? Do you have any concerns?
Is your pet currently on any medications or supplements? If so, please provide details.
Has you pet been boarding or travelled recently? If so, please provide details.
Are there any mobility or lameness concerns with your pet?
Are there any skin lesions or lumps/bumps on your pet?
Do you have any other concerns for your pet that you would like to discuss?
Untitled
- First Choice
- Second Choice
- Third Choice

Pet feeling blue? Use our online symptom checker. Pet Health Checker

Medical Appointment Questionnaire

Client's Name

Pet Information

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