Wellness Questionnaire

  • Thank you for your time in filling out this questionnaire before your pet's wellness visit. This form is intended to help us provide the best individualized preventative care for your pet.
  • Example:
    Brand Form Amount Number Fed Since
    Purina Pro Plan Dry 1 measuring cup (8oz) 2 x day Jan 2010
    Wellness Salmon Canned 1 5oz can 1 x day Jan 2012
    Greenies Dental Chew 1 chew 1 x day Jan 2012
    Lean ground beef Home cooked 1/2 cup 1 x day Jan 2010
  • Example: Frontline, Advantage, Revolution, Trifexis, Heartgard, Nexgard
  • Example: Itchiness/feet licking, arthritis, stiffness or exercise intolerance, weight gain, weight loss, coughing, vomiting, diarrhea, etc.
  • Examples: beaches, lakes/rivers, mountainous areas, wetlands, hiking trails, dog shows, dog kennels/boarding facilities, out of state(if so, what region of the US or abroad?)
Location Hours
Monday8:00am – 8:00pm
Tuesday8:00am – 8:00pm
Wednesday8:00am – 8:00pm
Thursday8:00am – 8:00pm
Friday8:00am – 8:00pm
Saturday8:00am – 5:00pm

For after hours emergency care contact United Veterinary Specialty & Emergency, they are centrally located in Campbell (408-371-6252) & San Jose (408-578-5622).