In an effort to keep our clients and staff as healthy as possible, we are limiting clients' ability to enter the facility directly. Because of this, we request that you fill out this exam summary electronically prior to your appointment. 1 Start 2 Complete Full Name (client/owner) * Best phone number for today's appointment: The Veterinarian and technician will use this number to communicate with you through the appointment. * Contact Information - Please update if anything has changed! Email Address * Phone Number Address Pet's Information Patients Name Species Cat Dog Sex Male Male/Neutered Female Female/Spayed Primary reason for appointment/concerns. Please be as detailed as possible * Pets energy level Normal Increased Decreased Is the patient on Flea and Tick Prevention? Yes No Unsure Is the patient on Heartworm Prevention? Yes No Unsure Please list all current medications. Note this is required for all new patients: What type/brand of food does the patient eat? How is your pet's appetite? Normal Increased Decreased How is your pet's water intake? Normal Increased Decreased Is your pet coughing? Yes No Not sure Is your pet sneezing? Yes No Not sure Is your pet vomiting? Yes No Not sure Does your pet have diarrhea? Yes No Not sure Describe your pet's urination: Normal Increased Decreased Dark Straining to Urinate Blood Present Cloudy Strong/Foul Odor Other If other, please explain Any previous history we should be aware of? Any additional information that you would like the Veterinarian to be aware of?
