Hit enter to search or ESC to close
About Us
Our Hospital
Who’s Who in the Hospital
Meet Our Team
Our Services
Acupuncture, Herbal Medicine & Food Therapy
Locations & Hours
Links
New Clients
As of Aug. 2022, we are unable to accept any new clients.
Take A Tour
What to Expect
New Client Registration
Dental info
Daycare & Training
Canine Classes
Crate Training
Doggie Daycare
Canine Socials
Training Resources
Fear Free
Feline Resources
Pet Travel
Pet Health
Pet Health Library
Pet Health Checker
How-To Videos
Pet Food Recalls
Product Recalls
News
Wellness Questionnaire 2
Today's Date
Date Format: MM slash DD slash YYYY
Owner's Name
First
Last
Pet's Name
Species
Cat
Dog
Other
Gender
Female
Female Spayed
Male
Male Neutered
Age/DOB
Describe your pet's daily activity level
Hyperactive
Active
Average
Minimal
Other
Has your pet's activity level changed since your last visit?
Yes
No
Have you noticed any stiffness or change in your pet's mobility?
Yes
No
Example: not jumping, slow to stand, etc.
How would you describe your pet's weight?
Underweight
Ideal body weight
Overweight
What is your pet's diet?
Example:
Brand: Nutro - Form: kibble - Amount: 1/4 cup - Frequency: 2 x day - Fed since: Jan 2010
How would you describe your pet's appetite and water consumption?
Minimal
Normal
Ravenous
Please list your pet's current medications.
Example:
Medication: Hydroxyzine - Strength: 10mg - Frequency: every 12 hours
Is your pet taking any supplements? (including naturopathic formulas, nutraceuticals, etc.)
Yes
No
Has your pet ever had a reaction to a vaccine, medication or food?
Yes
No
Is your pet on a flea and tick prevention?
Yes
No
Heartworm prevention?
Yes
No
What brand?
Advantage
Advantix
Cheristin
Comfortis
Heartgard
Revolution
Trifexis
Other
When was the last dose given?
Are there any chronic signs that your pet has that you would like to be addressed at this visit? Of these issues, which is the most concerning at this time?
Does your pet live
Indoor
Outdoor
Both
What kind of area do you live in?
Rural
Suburban
Urban
Does your pet go to a grooming facility on a regular basis?
Yes
No
Does your dog go to the dog park, daycare or boarding facility?
Yes
No
Are there raccoons, opossums, squirrels, deer, rodents or other wildlife species in your area?
Yes
No
Has your pet ever had...
Fleas
Ticks
Both
Is your dog a hunting dog?
Yes
No
Has your pet traveled within the last 3 years, where?
Will you be traveling with your pet in the future?
Yes
No
Do you have a second home that your pet visits regularly, where?
Are there small children, seniors or other immune compromised persons living with your pet?
Yes
No
If yes, are your interested in discussing potential animal to human disease transmission risks?
Yes
No
Are you interested in alternative medicine, such as acupuncture or laser therapy, for your pet?
Yes
No
About Us
Our Hospital
Who’s Who in the Hospital
Meet Our Team
Our Services
Acupuncture, Herbal Medicine & Food Therapy
Locations & Hours
Links
New Clients
As of Aug. 2022, we are unable to accept any new clients.
Take A Tour
What to Expect
New Client Registration
Dental info
Daycare & Training
Canine Classes
Crate Training
Doggie Daycare
Canine Socials
Training Resources
Fear Free
Feline Resources
Pet Travel
Pet Health
Pet Health Library
Pet Health Checker
How-To Videos
Pet Food Recalls
Product Recalls
News