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Owner Name
*
Phone
*
Email
*
Patient Name
*
Appointment Date
*
Reason for Visit
*
Does your pet have any previous problems or chronic conditions?
*
If yes, describe.
How is your pet's appetite?
*
Normal
Increased
Decreased
How is your pet's water intake?
*
Normal
Increased
Decreased
How is your pet's urination?
*
Normal
Increased
Decreased
Change in Color
Change in Odor
Other
Is your pet having diarrhea?
*
If yes, for how long?
Has your pet been vomiting?
*
If yes, how often and for how long?
How is your pet's activity level?
*
Normal
Increased
Decreased
Does your pet have any mobility issues?
*
Walking, Standing, Running, etc.
Have you noticed any changes in your pet's behavior?
*
If yes, describe.
Has your pet been sneezing, coughing, or had any other respiratory issues?
*
If yes, describe.
Does your pet have any issues with their Eyes, Mouth, Ears, Skin?
*
If yes, describe.
Is your pet currently taking any medications or supplements?
*
If yes, which ones?
What, How Much, and How Often do you feed your pet?
*
Type of food, 1 cup, 2 cups, Once daily, Twice daily, Free feed, Etc.
Do you travel with you pet or have they ever been away from the North Idaho area?
*
If yes, where?
Do you take your pet to a boarding or grooming facility, dog park, pet store, etc.?
*
How much time does your pet spend indoors vs. outdoors?
*
Is your pet currently on Flea, Tick, and/or Heartworm Prevention?
*
Is yes, what type?
Are there any topics that you would like to discuss at your visit?
*
Has your pet been exposed to anyone who is ill or who has a confirmed case of COVID-19? If yes, when were they exposed?
*
Home
New Clients
New Client Info
New Client Form
Practice Policies
About Us
About Our Hospital
Team
Location & Hours
Photo Gallery
February Photo Contest
News & Events
More Information
Services
All Services
Surgical Services
Medical Services
Anesthesia and Patient Monitoring
Preventive Services
Wellness and Vaccination Programs
Avian Medicine and Surgery
Additional Services
Emergency Care
Pet Health
Pet Health Info
Patient Medical History
Pet Health Library
Pet Health Checker
Pet Health News
How-To Videos
Online Store
Pet Page
Pet Records Registration
Pet Records Sign-in
Employee Spotlight