Dog Wellness Visit History

Thank you for the opportunity to provide exceptional care for your pet and professional courteous service for you. Thank you for your time in helping us understand your pet better. Together we can continue to preserve that special bond!

OWNER INFORMATION

PET INFORMATION

 

If this pet is new to our hospital, please complete the following:

 

 

MEDICAL HISTORY

Do you take your dog to the dog park? *
Do you take your dog to boarding? *
Do you take your dog to grooming? *
Do you take your dog to the pet store? *
Do you take your dog camping? *
Do you take your dog hunting? *
Do you take your dog to woods/trails/hiking? *
Do you take your dog swimming? *
Do you take your dog to therapy/nursing home/hospitals? *
Is your dog currently on heartworm prevention? *
Has your dog been vomiting? *
Has your dog had diarrhea? *
Has your dog been limping? *
Has your dog been itching? *
Has your dog had a change in appetite? *

Has your dog had a change in thirst? *
Has your dog had a decrease or increase in urination? *
Would you like your dog to receive a nail trim ($26.04 plus tax)? *
Would you like your dog to receive anal gland expression ($37.30 plus tax)? *
Would you like your dog to receive a 4dx Heartworm/Tick Disease Screening test ($87.58 plus taxes)? *

This is a comprehensive blood panel recommended yearly for all dogs over 6 years of age. Having bloodwork done for geriatric pets is crucial for longevity, early detection of disease and management of conditions. Approximate cost $245 (including cbc/chemistry/4dx heartworm/tick disease screening.


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