Medical History Form

Medical History


Contact Information

MY PET’S CLINICAL HISTORY

Your information together with the physical exam and the lab tests are the tools that help us arrive at a diagnosis.

Yes No I Don’t Know Details
Shots up to date
Tick control
Heartworm control
Last time in heat /was bred
My pet is neutered/spayed
Has behavioral issues
Has chronic illness
Is currently taking medication
Surgeries had in the last 3 months
Normal Increased Decreased Absent Other-Specify
Appetite
Drinks water
Hair and skin
State of alertness
Stool
Vomiting
Urine
Foul odor
Mobility
Pain
Itchiness

Family & Housing

Any additional information or special instructions please write below.

It is imperative that you call 1-877-787-7728
after the application is filled out.



IMPORTANT:

  • Please make sure your pet does not eat nor drink after 6 am
  • Please bring a crate for your pet
  • Please bring a rabies certificate
  • Stitches will need to be taken out two weeks post surgery, call 1-877-787-7728 to schedule.